Wehrmann T, Kokabpick S, Lembcke B, Caspary W F, Seifert H
Department of Internal Medicine II, J.W. Goethe University Hospital, Frankfurt am Main, Germany.
Gastrointest Endosc. 1999 Jun;49(6):677-83. doi: 10.1016/s0016-5107(99)70281-6.
Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The short-acting anesthetic propofol offers certain potential advantages for endoscopic procedures, but controlled studies proving its superiority over benzodiazepines for ERCP are lacking.
During a 6-month period 198 consecutive patients undergoing routine ERCP randomly received either midazolam (n = 98) or propofol (n = 99) for sedation. Vital signs (heart rate, blood pressure, oxygen saturation) were continuously monitored and procedure-related parameters, the recovery time and quality (recovery score) as well as the patient's cooperation and tolerance of the procedure (visual analog scales) were prospectively assessed.
Patients receiving propofol or midazolam were well matched with respect to demographic and clinical data, ERCP findings, and the performance of associated procedures. Propofol caused a more rapid onset of sedation than midazolam (p < 0.01). Clinically relevant changes in vital signs were observed at comparable frequencies with temporary oxygen desaturation occurring (< 85 %) in 6 patients in the propofol group and 4 patients receiving midazolam (not significant). However, an episode of apnea had to be managed by mask ventilation via an ambu bag (lasting 8 minutes) in one of the patients receiving propofol sedation. Mean recovery times as well as the recovery scores were significantly shorter with propofol (p < 0. 01). Propofol provided significantly better patient cooperation than midazolam ( p < 0.01), but procedure tolerability was rated the same by both groups of patients (not significant).
Intravenous sedation with propofol for ERCP is (1) more effective than sedation with midazolam, (2) safe under adequate patient monitoring, and (3) associated with a faster postprocedure recovery.
在诊断性和治疗性内镜逆行胰胆管造影术（ERCP）中，充分的患者镇静是必不可少的。短效麻醉剂丙泊酚在内镜检查中具有一定的潜在优势，但缺乏对照研究证明其在ERCP方面优于苯二氮䓬类药物。
在6个月期间，198例接受常规ERCP的连续患者被随机给予咪达唑仑（n = 98）或丙泊酚（n = 99）进行镇静。持续监测生命体征（心率、血压、血氧饱和度），并前瞻性评估与手术相关的参数、恢复时间和质量（恢复评分）以及患者对手术的配合度和耐受性（视觉模拟量表）。
接受丙泊酚或咪达唑仑的患者在人口统计学和临床数据、ERCP检查结果以及相关手术的实施方面匹配良好。丙泊酚引起的镇静起效比咪达唑仑更快（p < 0.01）。生命体征的临床相关变化以相似的频率出现，丙泊酚组有6例患者出现短暂性氧饱和度下降（< 85%），接受咪达唑仑的患者有4例（无统计学意义）。然而，在接受丙泊酚镇静的1例患者中，必须通过复苏袋面罩通气处理一次呼吸暂停发作（持续8分钟）。丙泊酚的平均恢复时间和恢复评分明显更短（p < 0.01）。丙泊酚提供的患者配合度明显优于咪达唑仑（p < 0.01），但两组患者对手术的耐受性评分相同（无统计学意义）。
ERCP术中静脉注射丙泊酚镇静（1）比咪达唑仑镇静更有效，（2）在充分的患者监测下是安全的，（3）与术后更快恢复相关。
