Application Of Different Degree Painless Scheme In Gastroscopic Diagnosis And Treatment Of Patients With Decompensated Cirrhosis

ObjectComparing effect,safety and satisfaction of moderate and deep sedation/anesthesia gastroscope for patients,decompensated cirrhosis of the liver,provides a theoretical basis for guiding clinical formulation of individualized painless gastroscope.MethodFrom January 2018 to July 2018 in Tianjin Third Central Hospital,patients with decompensated cirrhosis who needed diagnosis and treatment under gastroscope were selected.They were divided into moderate sedation group?sedation group,for short?and deep sedation/anesthesia group?anesthesia group,for short?according to the painless method before gastroscopy.Before operation,recording sex,age,weight,ASA grading,Child-Pugh grade,blood routine.During operation,recording Ramsay score changes,drug onset time,gastroscopy operation time,consciousness recovery time.Recording patients'vital signs when entering the room?T₀?,drugs working?T₁?,and finishing the operation?T₂?,and adverse reactions.Completing patient's subjective questionnaire within 24 hours.Drugs effect,safety and patients'subjective feelings of both groups were compared by SPSS21.0.Result1.A total of 271patients were included in this study.219 were in sedation group and 52 were in anesthesia group.2.There were 136 patients in Child-Pugh A,90?66.2%?in sedation group and 46?33.8%?in anesthesia group;101 patients in Child-Pugh B,96?95.0%?in sedation group,and 5?5.0%?in anesthesia group;34 patients in Child-Pugh C,33?97.1%?in sedation group,and 1?2.9%?in anesthesia group.The selection rate of the moderate sedative solution was increased with the increase of the Child-Pugh classification,P<0.05.3.There were 186 patients with mild anemia,140?75.3%?in sedation group,and46?24.7%?in anesthesia group;73 patients with moderate anemia,67?91.8%?in sedation group,6?8.2%?in anesthesia group;12 patients with severe anemia,all of them were in sedation group.There were 128 patients with mild thrombocytopenia,97?75.8%?in sedation group and 31?24.2%?in anesthesia group.There were 87patients with moderate thrombocytopenia,67?77%?in sedation group and 20?23%?in anesthesia group.There were 56 patients with severe thrombocytopenia,55?98.2%?in sedation group,and 1?1.8%?in anesthesia group.The selection rate of moderate sedation was increased with the increase of anemia and thrombocytopenia,P<0.05.4.The Ramsay score of sedation group at the same time was lower than that in anesthesia group?T₁:4.89±0.36 points vs 5.87±0.19 points;T₂:4.07±1.13 points vs 5.85±0.47 points?,P<0.05.The drugs onset in sedation group was slower?2.42±1.72 min vs 1.26±0.43 min?,while the consciousness recovery was faster?0.60±0.47 min vs 6.53±1.44 min?than that in anesthesia group,P<0.05.5.Compared with T₀SBP,T₁SBP in sedation group decreased by 13.65±12.23mmHg,and T₁SBP in anesthesia group decreased by 24.08±11.72mmHg.In sedation group,T₁HR decreased by 3.46±2.38 times/min compared with T₀HR,and in anesthesia group,T₁HR decreased by 11.08±8.45 times/min compared with T₀HR.T₁SpO₂ in sedation group was 1.01±0.33%lower than T₀SpO₂,and T₁SpO₂ in anesthesia group was 1.92±0.81%lower than T₀SpO₂.Moderate sedation has less effect on SBP,HR,and SpO₂ than deep sedation/anesthesia,P<0.056.Among sedation group,patient satisfaction was 89.5%,intraoperative amnesia was 90.9%,and secondary acceptance was 94.1%.These surveys had no significant differences between sedation group and anesthesia group.7.The incidence of adverse reactions in sedation group was lower than that in anesthesia group?8.7%vs 19.2%?,P<0.05.Conclusion1.Moderate sedation can meet the"painless"requirements in gastroscopic diagnosis and treatment of decompensated cirrhosis.Patient satisfaction,intraoperative forgetting and secondary acceptance were high.2.Moderate sedation has little effect on respiratory circulation system,especially on systolic pressure,heart rate,pulse oxygen saturation,when compared with deep sedation/anesthesia,and the incidence of adverse reactions is low,and the patient's consciousness recovers quickly.3.Under closely ECG monitoring,experienced endoscopy doctors can perform moderate sedative painless gastroscopy on Child-Pugh C,severe anemia or thrombocytopenia patients.