Meining A, Semmler V, Kassem A M, Sander R, Frankenberger U, Burzin M, Reichenberger J, Bajbouj M, Prinz C, Schmid R M
Medical Department II, Technical University of Munich, Munich, Germany.
Endoscopy. 2007 Apr;39(4):345-9. doi: 10.1055/s-2006-945195. Epub 2007 Feb 7.
Sedation with propofol is associated with a high acceptance rate in upper gastrointestinal endoscopy. So far, however, there are no valid data on whether the use of propofol can increase the general quality of the endoscopic examination.
A total of 60 patients referred for upper gastrointestinal endoscopy were randomized to receive sedation with either midazolam (n = 30) or propofol (n = 30). The maximum dosages permitted were 5 mg of midazolam and 500 mg of propofol. The examinations were recorded on videotapes, and the quality of upper endoscopy was assessed by videotape analysis by three experienced endoscopists who were all blinded to patient data and the medications used for sedation. A score sheet was used with 18 assessment items that each represented a step of upper gastrointestinal endoscopy and a global score for the entire examination. A scale ranging from 1 (excellent) to 6 (very poor) was used. Data were analyzed on an intention-to-investigate basis: inability to perform the procedure because of a patient's intolerance of the procedure, for example, was scored as 6 (i. e. very poor).
Patients in the two groups were well matched with respect to demographic and clinical data. Four patients in the midazolam group could not be adequately examined. The median dosage used for sedation was 5 mg midazolam (range 2-5 mg) and 160 mg propofol (range 70-320 mg). When assessments by all three blinded examiners were added together, propofol sedation was found to result in significantly better scores for all parameters except for the assessments of "Z-line/cardia", "duodenal bulb", and "duodenal folds" (all P < 0.05, Mann-Whitney U test).
Sedation with propofol might increase the quality of upper endoscopy. This finding may have a significant impact on the selection of the type of sedation, not only in terms of increasing patients' acceptance of the procedure, but also for improving the diagnostic accuracy of upper gastrointestinal endoscopy.
丙泊酚镇静在上消化道内镜检查中具有较高的接受率。然而，迄今为止，关于丙泊酚的使用是否能提高内镜检查的总体质量尚无有效数据。
共有60例因上消化道内镜检查前来就诊的患者被随机分为两组，分别接受咪达唑仑（n = 30）或丙泊酚（n = 30）镇静。允许使用的最大剂量分别为5 mg咪达唑仑和500 mg丙泊酚。检查过程被录制在录像带上，由三名经验丰富的内镜医师通过录像带分析对上消化道内镜检查的质量进行评估，这三名医师均对患者数据和用于镇静的药物不知情。使用一份包含18个评估项目的评分表，每个项目代表上消化道内镜检查的一个步骤，以及整个检查的总体评分。采用从1（优秀）到6（非常差）的评分标准。数据按意向性分析：例如，因患者不耐受操作而无法进行检查的情况被评为6分（即非常差）。
两组患者在人口统计学和临床数据方面匹配良好。咪达唑仑组有4例患者未能得到充分检查。镇静所用的中位剂量为5 mg咪达唑仑（范围2 - 5 mg）和160 mg丙泊酚（范围70 - 320 mg）。当将三位不知情检查者的评估结果相加时，发现除了对“齿状线/贲门”、“十二指肠球部”和“十二指肠皱襞”的评估外，丙泊酚镇静在所有参数上的得分均显著更高（所有P < 0.05，曼-惠特尼U检验）。
丙泊酚镇静可能会提高上消化道内镜检查的质量。这一发现可能会对镇静类型的选择产生重大影响，不仅在于提高患者对检查的接受度，还在于提高上消化道内镜检查的诊断准确性。
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