超细胃镜及检查前沟通在早期胃癌患者胃镜复查中的应用

摘要

目的 探讨超细电子经鼻胃镜以及检查前沟通对早期胃癌患者胃镜复查中的应用价值.方法 选取2015年1月-2015年12月在该院经胃镜及病理检查确诊为早期胃癌患者400例,3个月内复查时随机抽取200例为普通胃镜经口插入组(Ⅰ组),200例为超细胃镜经鼻插入组(Ⅱ组).每组中又随机挑选部分患者进行检查前沟通及告知.术中记录心率、血压、呕吐次数及肢体配合情况并采集图像,调查问卷调查患者对胃镜检查的接受程度.结果 超细胃镜经鼻插入组(Ⅱ组)血压及心率均较普通胃镜经口插入组(Ⅰ组)低(P＜0.05),且两组患者均为有过明确检查前交代的其血压心率控制在较好范围.超细胃镜经鼻插入组(Ⅱ组)恶心呕吐反应均较普通胃镜经口插入组(Ⅰ组)轻(x2=163.262,P=0.001),且两组患者均为有过明确检查前交代的其恶心呕吐反应较轻(Ⅰ组:x2=142.431,P=0.042,Ⅱ组:x2=152.713,P=0.034).超细胃镜经鼻插入组(Ⅱ组)肢体配合情况均较普通胃镜经口插入组(Ⅰ组)好(x 2=178.191,P=0.001),且两组患者均为有过明确检查前交代的其肢体配合情况较为良好(Ⅰ组:x2=151.213,P=0.032;Ⅱ组:x 2=158.214,P=0.024).超细胃镜经鼻插入组(Ⅱ组)胃镜接受程度均较普通胃镜经口插入组(Ⅰ组)高(x2=163.262,p=0.001),且两组早期胃癌患者均为有过明确检查前交代的其接受胃镜治疗程度较好(Ⅰ组:x2=142.233,P=0.045;Ⅱ组:x2=148.232,P=0.033).超细胃镜经鼻插入组(Ⅱ组)早期胃癌胃镜成像情况较普通胃镜经口插入组(Ⅰ组)镜下成像无差异.结论 超细胃镜经鼻插入并有明确病情交代有利于患者心率血压的控制,减轻恶心呕吐反应,提高肢体配合程度,提高胃镜治疗接受程度,以避免各种不良反应的发生.%Objective To investigate the application value of ultra-slim electronic transnasal gastroscopy and preoperative communication in the gastroscopic review of patients with early gastric cancer.Methods A total of 400 patients diagnosed with early gastric cancer by gastroscopy and pathologic verification were randomly divided into two groups within three months' review from January 2015 to December 2015,200 of them were included into the control group (general gastroscope for oral insertion,group Ⅰ) and the remaining were included in the experimental group (ultra-slim gastroscope for nasal insertion,group Ⅱ).Some of the patients were selected randomly from the groups to receive preoperative communication and notification.Heart rate,blood pressure,vomiting response,body coordination and images were recorded intraoperatively,and acceptance of gastroscopy was measured by questionnaires.Results The patients with early gastric cancer who accepted the ultra-slim gastroscope for nasal insertion (group Ⅱ) performed better range of heart rate and blood pressure than the patients who accepted general gastroscope for oral insertion (group Ⅰ) (P ＜ 0.05).The patients in group Ⅱ had less vomiting response than those in the group Ⅰ (x2=163.262,P=0.001).All the patients had preoperative interpretation of slight nausea and vomiting reactions (group Ⅰ:x2 =142.431,P=0.042;group Ⅱ:x2=152.713,P =0.034).The patients in the group Ⅱ had better body coordination than those in the group Ⅰ (x2=178.191,P =0.001).All the patients had preoperative interpretation of good body coordination.(group Ⅰ:x2=151.213,P=0.032;group lⅡ:x2=158.214,P=0.024).The patients in the group Ⅱ performed higher acceptance level than those in the group Ⅰ (x2=163.262,P=0.001).All the patients had preoperative interpretation of good acceptance level (group Ⅰ:x2=142.233,P=0.045;group Ⅱ:x2=148.232,P =0.033).There was no obvious difference in imaging between the groups.Conclusions The patients with early gastric cancer who accepted the ultr-slim gastroscopy for nasal insertion and preoperative communication perform better range of heart rate and blood pressure,less vomiting response,better body coordination and higher acceptance level than the patients who accepted general gastroscopy for oral insertion,which can avoid the occurrence of various adverse reactions.