Heuss L T, Schnieper P, Drewe J, Pflimlin E, Beglinger C
Department of Gastroenterology, University Hospital Basel, Basel, Switzerland.
Aliment Pharmacol Ther. 2003 Jun 15;17(12):1493-501. doi: 10.1046/j.1365-2036.2003.01608.x.
To characterize the safety of endoscopic procedures and propofol use as administered by nurses in a cohort of elderly patients.
During 19 months all endoscopy patients > 70 years were eligible for this prospective observational study. Patients were assigned to group A (70-85 years) or group B (> 85 years). Records from all patients < 70 years treated during the same period served as controls. Specially trained nurses administered the propofol and monitored for complications (decrease in the peripheral oxygen saturation, mean arterial pressure or heart rate).
There were 1435 endoscopic procedures in group A and 351 in group B. There was no procedure or sedation-related mortality, nor a significantly greater need for emergency intervention than in the control group. Two patients required short mask ventilation but recovered without sequelae. Compared with younger patients, there was a significant increase in risk for a short oxygen desaturation < 90% and a decrease in oxygen saturation > 5%. Arterial hypotension occurred significantly more often in the control group than among the aged patients.
This present study documents that gastrointestinal endoscopic procedures are safe and well tolerated even in the very elderly. Nurse-administered propofol is a safe and reasonable sedation method in these patients.
在一组老年患者中，描述由护士实施的内镜检查程序及丙泊酚使用的安全性。
在19个月期间，所有70岁以上的内镜检查患者均符合这项前瞻性观察性研究的条件。患者被分为A组（70 - 85岁）或B组（> 85岁）。同期治疗的所有70岁以下患者的记录作为对照。经过专门培训的护士给予丙泊酚并监测并发症（外周血氧饱和度、平均动脉压或心率下降）。
A组有1435例内镜检查程序，B组有351例。没有与检查程序或镇静相关的死亡病例，与对照组相比，也没有明显更高的紧急干预需求。两名患者需要短时间面罩通气，但恢复后无后遗症。与年轻患者相比，血氧饱和度短时间< ９０％的风险显著增加，血氧饱和度下降> 5％的情况减少。对照组中动脉低血压的发生明显比老年患者更频繁。
本研究证明，即使在高龄患者中，胃肠内镜检查程序也是安全且耐受性良好的。护士给予丙泊酚对这些患者来说是一种安全且合理的镇静方法。
