Tohda G, Higashi S, Sakumoto H, Sumiyoshi K, Kane T
Department of Gastroenterology, Yujin Yamazaki Hospital, Hikone, Shiga, Japan.
Endoscopy. 2006 Jul;38(7):684-9. doi: 10.1055/s-2006-925374. Epub 2006 Jun 6.
Recent studies have documented the safety of propofol sedation for endoscopic procedures, but many endoscopists are reluctant to use propofol for high-risk patients because of adverse effects. The aim of this study was to demonstrate the safety and efficacy of nurse-administered propofol sedation during emergency upper endoscopy for patients with gastrointestinal bleeding.
Over a period of 18 months, 120 patients suffering from acute upper gastrointestinal bleeding received propofol sedation administered by a registered nurse. Among these, 15 patients were classified into American Society of Anesthesiologists (ASA) class IV, 84 were ASA class III, and 21 were ASA class II. Patients without gastrointestinal bleeding, who also received propofol during the same period and were matched for age, gender, and ASA class, served as controls.
Endoscopic hemostasis was achieved in 98.3 % of patients, and 97.5 % were satisfied with the procedure. In patients with gastrointestinal bleeding, the rates of hypotension (systolic blood pressure < 90 mmHg) and hypoxemia (peripheral oxygen saturation < 90 %) were 8.3 % and 6.7 % respectively, values higher than those in the control group. However, neither mask ventilation nor endotracheal intubation was necessary. Although two patients with gastrointestinal bleeding developed pneumonia, most likely due to aspiration during the procedure, they recovered within 5 days of treatment. There were no sedation-associated severe complications or mortalities.
Using a strict protocol designed to protect the patient's airway and cardiovascular function, nurse-administered propofol sedation during emergency upper gastrointestinal endoscopy is safe and appropriate in cases of acute gastrointestinal bleeding.
近期研究已证明丙泊酚用于内镜操作镇静的安全性，但许多内镜医师因不良反应而不愿在高风险患者中使用丙泊酚。本研究的目的是证明在急诊上消化道内镜检查期间，由护士给予丙泊酚镇静对胃肠道出血患者的安全性和有效性。
在18个月的时间里，120例急性上消化道出血患者接受了由注册护士给予的丙泊酚镇静。其中，15例患者被分类为美国麻醉医师协会（ASA）IV级，84例为ASA III级，21例为ASA II级。同期接受丙泊酚镇静且年龄、性别和ASA分级相匹配的无胃肠道出血患者作为对照。
98.3%的患者实现了内镜止血，97.5%的患者对该操作满意。在胃肠道出血患者中，低血压（收缩压<90 mmHg）和低氧血症（外周血氧饱和度<90%）的发生率分别为8.3%和6.7%，高于对照组。然而，面罩通气和气管插管均无必要。尽管有2例胃肠道出血患者发生了肺炎，很可能是由于操作期间的误吸，但他们在治疗5天内康复。没有与镇静相关的严重并发症或死亡病例。
采用旨在保护患者气道和心血管功能的严格方案，在急诊上消化道内镜检查期间由护士给予丙泊酚镇静对于急性胃肠道出血病例是安全且合适的。
