Michaud L, Gottrand F, Ganga-Zandzou P S, Ouali M, Vetter-Laffargue A, Lambilliotte A, Dalmas S, Turck D
Department of Pediatric Gastroenterology, Lille University Hospital, France.
J Pediatr Gastroenterol Nutr. 1999 Mar;28(3):310-4. doi: 10.1097/00005176-199903000-00018.
The ideal medication to administer to children before gastrointestinal endoscopy procedures has yet to be found. The efficacy of using inhaled nitrous oxide during endoscopy in children was assessed in a pilot study.
Patients aged 5 to 17 years, referred to our hospital for diagnostic upper gastrointestinal endoscopy or rectosigmoidoscopy procedures, were eligible for enrollment in this study. All received 50% nitrous oxide in oxygen (Entonox; AGA, Rueil-Malmaison, France) before endoscopy and some of them again during endoscopy. The pediatric endoscopist and the nurse performing the procedure were separately asked to rate cooperation, emotional state, drowsiness and overall efficacy of sedation. Oxygen saturation and adverse effects were recorded throughout the procedure. After endoscopy, children scored their degree of pain during the procedures on a visual analog scale (0, no pain; 100, agony) and on a body outline (projective method). Any adverse effects were noted.
Thirty-seven patients were enrolled in the study. Thirty patients underwent diagnostic upper gastrointestinal endoscopy and seven diagnostic rectosigmoidoscopy. The median time from administration of nitrous oxide until insertion of the endoscope was 5 minutes (range, 3-8 minutes). Good or excellent efficacy of the sedation was noted in 92% of children by the endoscopist and in 89% by the nurses. Good or excellent cooperation was noted in 92% of the children by the endoscopist and in 78% by the nurses. The children's pain score on the visual analog scale ranged from 5 to 100 (median, 20) for upper gastrointestinal endoscopy and from 0 to 30 (median, 0) for rectosigmoidoscopy. The time of discharge after endoscopy, defined as the time elapsed between the end of the endoscopy and discharge from the endoscopy suite, varied from 1 to 7 minutes (median, 1.5 minutes).
Entonox provides rapid and effective analgesia without heavy sedation, leads to adequate relaxation and cooperation, and facilitates quick and efficient endoscopy. The effect of Entonox was of short duration, allowing the children to leave the endoscopy unit without need for a long recovery period. The adverse effects of Entonox appeared to be minor, and their duration was always brief. Nitrous oxide-oxygen inhalation may provide a valuable alternative to conventional sedation regimens during gastrointestinal endoscopy in children, but randomized and prospective studies comparing nitrous oxide sedation and conventional sedation regimens are necessary.
尚未找到用于儿童胃肠内镜检查术前的理想药物。一项初步研究评估了儿童内镜检查期间使用吸入性一氧化二氮的疗效。
年龄在5至17岁、因诊断性上消化道内镜检查或直肠乙状结肠镜检查转诊至我院的患者符合本研究的入组条件。所有患者在内镜检查前均接受了50%氧化亚氮与氧气的混合气（恩多诺克斯；法国阿加法公司，鲁耶 - 马尔迈松），部分患者在内镜检查期间再次使用。分别要求儿科内镜医师和执行操作的护士对合作程度、情绪状态、嗜睡情况及镇静的总体效果进行评分。在整个操作过程中记录血氧饱和度和不良反应。内镜检查后，让儿童在视觉模拟量表（0表示无疼痛；100表示剧痛）和身体轮廓图（投射法）上对操作过程中的疼痛程度进行评分。记录任何不良反应。
37例患者纳入本研究。30例患者接受了诊断性上消化道内镜检查，7例接受了诊断性直肠乙状结肠镜检查。从给予一氧化二氮到插入内镜的中位时间为5分钟（范围3 - 8分钟）。内镜医师评估92%的儿童镇静效果良好或极佳，护士评估为89%。内镜医师评估92%的儿童合作良好或极佳，护士评估为78%。上消化道内镜检查时，儿童在视觉模拟量表上的疼痛评分范围为5至100（中位值20），直肠乙状结肠镜检查时为0至30（中位值0）。内镜检查后的出院时间定义为内镜检查结束至离开内镜检查室的时间，为1至7分钟（中位值1.5分钟）。
恩多诺克斯可提供快速有效的镇痛，且无深度镇静，能实现充分的放松与合作，便于快速高效地完成内镜检查。恩多诺克斯的作用持续时间短，使儿童无需长时间恢复即可离开内镜检查科室。恩多诺克斯的不良反应似乎较小，且持续时间总是很短。在儿童胃肠内镜检查期间，吸入一氧化二氮 - 氧气混合气可能是传统镇静方案的一种有价值的替代方法，但有必要进行比较一氧化二氮镇静和传统镇静方案的随机前瞻性研究。
