Rosenberg J, Jørgensen L N, Rasmussen V, Vibits H, Hansen P E
Dept. of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
Scand J Gastroenterol. 1992 Aug;27(8):717-20. doi: 10.3109/00365529209000147.
Sixteen non-selected patients undergoing endoscopic cholangiopancreatography (ERCP) after diazepam premedication were monitored for oxygen saturation (SpO2) with a pulse oximeter and for myocardial ischaemia with a Holter tape recorder from 2 h before ERCP to 6 h after the procedure. One patient was excluded from data analysis because of oxygen therapy. Oxygen saturation was significantly decreased (p less than 0.05) both during endoscopy and in the postendoscopy recovery period. Heart rate was significantly increased (p less than 0.05) both during and after the procedure. ST depression occurred in no patients before endoscopy, in 10 patients during, and in no patients after endoscopy. Concurrent ischaemia and episodic hypoxaemia were found in 5 patients, isolated ischaemia in 7 patients, and isolated episodic hypoxaemia in 13 patients. Concurrent ischaemia and tachycardia were found in 10 patients, ischaemia without tachycardia in no patients, and isolated tachycardia in 1 patient. There was no significant correlation between diazepam dose and SpO2 during endoscopy. These results suggest tachycardia to be more important than hypoxaemia in the pathogenesis of myocardial ischaemia during upper gastrointestinal endoscopy. Cardioprotective measures other than oxygen therapy should soon be evaluated before the implications of the new standards of care in endoscopy have become generally adopted.
对16例在接受地西泮术前用药后行内镜下胰胆管造影术（ERCP）的非选择性患者，使用脉搏血氧仪监测氧饱和度（SpO2），并使用动态心电图记录仪从ERCP术前2小时至术后6小时监测心肌缺血情况。1例因接受氧疗的患者被排除在数据分析之外。在内镜检查期间和内镜检查后恢复期，氧饱和度均显著降低（p<0.05）。手术期间和术后心率均显著升高（p<0.05）。内镜检查前无患者出现ST段压低，检查期间有10例患者出现，检查后无患者出现。5例患者同时存在缺血和发作性低氧血症，7例患者存在孤立性缺血，13例患者存在孤立性发作性低氧血症。10例患者同时存在缺血和心动过速，无患者存在无心动过速的缺血，1例患者存在孤立性心动过速。内镜检查期间地西泮剂量与SpO2之间无显著相关性。这些结果表明，在上消化道内镜检查期间，心动过速在心肌缺血发病机制中比低氧血症更重要。在普遍采用内镜检查新护理标准的影响之前，应尽快评估除氧疗之外的心脏保护措施。
