目的:探讨内窥镜治疗上消化道异物患者中不同异物的取出方法,提高异物取出成功率.方法:收集采用内窥镜治疗的上消化道异物患者2542例上消化道异物资料,对比分析消化道异物的大小或长短、形状、嵌顿部位和时间以及不同异物类型采用不同器械取出方法的成功率.结果:在2542例上消化道异物患者中,异物取出率为96.2%(2446/2542),其中鱼骨取出率为98.3%(967/984),禽骨取出率为96.5%(356/369),枣核取出率为94.8%(273/280)等.不同部位异物中食管异物取出率为96.8%(2114/2185),胃内异物取出率为96.6%(281/291),十二指肠异物取出率为73.5%(25/34),咽部异物取出率为81.0%(17/21),梨状窝异物取出率为77.8%(7/9).不同器械中异物钳取异物占91.1%(2317/2542),圈套器取异物占2.4%(62/2542),取石网篮取异物占1.3%(34/2542),内窥镜推入胃内占3.0%(77/2542).在2542例上消化道异物嵌顿患者中,有13例特殊困难异物嵌顿患者均通过黏膜下切开探查,其中6例成功取出,占46.2%(6/13).结论:内窥镜治疗上消化道异物操作简易、可视性好,对于上消化道异物类型、时机及嵌顿部位选择合适的器械和取出方法,有利于提高异物取出率,降低并发症发生.

Objective To promote best discharge practice in sedated patients′ following endoscopic procedures in an endoscopy center in Shanghai, China. Methods A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Eight audit criteria that were representative of best practice recommendations for discharge following endoscopic sedation procedures were used. A baseline audit was conducted followed by the implementation of multiple strategies, determined by the key stakeholders. The project was finalized with a follow-up audit to determine change in practice. Results Improvements in practice were observed for all eight criteria. The most significant improvements were in the following: completion of an organizational policy, the minimum discharge criteria, patient has met minimum discharge criteria before being discharged (all from 0% to 100% compliance), and giving verbal and written instructions (from 12% to 100% compliance). Criteria 4 (the authority to discharge), 6 (staff training and education) and 7 (being accompanied by family) achieved the least improvement in compliance rates, as baseline measures already showed a high degree of compliance. The compliance rate for criterion 8 (medical file) attained 88%. Conclusion This protocol utilized a clinical audit process leading to improvements in practice behavior related to patient discharge following endoscopic sedation procedures. A continuous cycle of audit and re-audit will be required in the future to maintain high quality standards.