静脉全身麻醉后拔管行序贯无痛胃镜治疗食管胃静脉曲张出血的安全性研究OA

Objective To evaluate the safety and therapeutic efficacy of sequential painless gastroscopy following the removal of a Sengstaken-Blakemore tube under intravenous general anesthesia in patients with esophagogastric variceal bleeding(EVB)after successful tamponade.Methods A retrospective analysis was conducted on 56 patients with acute EVB successfully controlled by a Sengstaken-Blakemore tube between January 2020 and December 2024.Based on whether tube removal and gastroscopy was performed under intravenous general anesthesia,patients were divided into two groups:the anesthesia extubation gastroscopy group(painless group,n=27)and the awake extubation gastroscopy group(waking group,n=29).Safety outcomes,efficacy outcomes,and impact-related outcomes were compared between the two groups.Results The incidence of aspiration pneumonia post-treatment was 3.70%(1/27)in the painless group and 3.45%(1/29)in the waking group,showing no significant difference(P=0.944).The incidence of hepatic encephalopathy post-treatment was 7.41%(2/27,all stage Ⅰ)in the painless group and 0.00%in the waking group,with no statistically significant difference(P=0.228).The immediate rebleeding rate after tube removal was lower in the painless group(11.11%,3/27)compared to the waking group(20.69%,6/29),though the difference was not statistically significant(P=0.472).Among them,the bleeding rate during endoscopy after extubation in the painless group was 3.70%(1/27),which was lower than 13.79%(4/29)in the waking group,but there was no statistically significant difference between the two groups(P=0.353).Short-term rebleeding rate after sequential endoscopic therapy was 3.70%(1/27)in the painless group and 6.90%(2/29)in the waking group,with no significant difference(P=0.596).The incidence of tube removal-induced stress reactions was 0.00%(0/27)in the painless group and 65.52%(19/29)in the waking group,demonstrating a statistically significant difference(P=0.000).The interference rate with gastroscopic treatment was 7.41%(2/27)in the painless group and 44.83%(13/29)in the waking group,showing a statistically significant difference(P=0.002).Conclusion Tube removal under anesthesia followed by sequential painless gastroscopy does not increase anesthesia-related adverse events,reduces the incidence of tube removal-induced stress reactions and interference with gastroscopic treatment,and may further decrease the immediate and short-term rebleeding rates after Sengstaken-Blakemore tube removal.