静脉镇静在上消化道诊断性内镜检查中的有效性。
The effectiveness of intravenous sedation in diagnostic upper gastrointestinal endoscopy.
作者信息
Amornyotin Somchai, Lertakayamanee Narong, Wongyingsinn Mingkwan, Pimukmanuskit Parichat, Chalayonnavin Viyada
机构信息
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
出版信息
J Med Assoc Thai. 2007 Feb;90(2):301-6.
BACKGROUND
Topical pharyngeal anesthesia is required to perform a technically adequate esophago-gastroduodenoscopy (EGD), but does not improve patient satisfaction, comfort, and willingness to repeat, particularly in the elderly and those with increased pharyngeal sensitivity. The comparative effectiveness of intravenous sedation versus no sedation remains poorly characterized.
OBJECTIVE
To compare the effectiveness of diagnostic EGD with and without intravenous sedation in an adult Thai population.
MATERIAL AND METHOD
A randomized controlled trial assigned patients into two groups, group C (topical pharyngeal anesthesia alone) and group I (intravenous sedation and topical pharyngeal anesthesia). All patients were topicalized with lidocaine viscous and spray. The patients in group I were sedated with midazolam 0.035 mg x kg(-1) and maintained with continuous propofol infusion. The ease of procedure and patient tolerance were evaluated. Secondary outcomes included patient and endoscoptist satisfaction, total time to awake, and willingness to repeat the procedure.
RESULTS
One hundred and seventy patients (mean age 50.5, 41.2% male) were randomized (group C = 85 and group I = 85; intervention) into two groups. Among patients of the two groups, 100% of the procedures were "successful". In group C, 98.8% were satisfied with their level of tolerance (comfort) while the group I had 100%. The willingness to repeat was 6.2 +/- 1.6 in group C while group I had 9.4 +/- 0.8. Patient and endoscopist satisfaction in group I was more satisfied than in group C (90.6% vs 35.3% and 81.2% vs 40.0% respectively) (p < 0.001). In group I, total amount of propofol was 91.6 +/- 45.5 mg and total time to awake was 8.2 +/- 4.2 min. The use of sedation was the major determinant of patient satisfaction, but contributed to an increased recovery room time. Hypertension and tachycardia were the most complications in group C, and hypotension was the most complication in group I.
CONCLUSION
In the average Thai adult population, sedated diagnostic EGD is a good strategy to increase endoscopist satisfaction and willingness to repeat.
背景
进行技术上足够的食管胃十二指肠镜检查（EGD）需要咽部局部麻醉，但这并不能提高患者满意度、舒适度和再次检查的意愿，特别是在老年人和咽部敏感性增加的患者中。静脉镇静与不进行镇静的比较效果仍不清楚。
目的
比较在泰国成年人群中进行诊断性EGD时使用和不使用静脉镇静的效果。
材料与方法
一项随机对照试验将患者分为两组，C组（仅咽部局部麻醉）和I组（静脉镇静加咽部局部麻醉）。所有患者均使用利多卡因粘性溶液和喷雾剂进行局部麻醉。I组患者用咪达唑仑0.035mg/kg静脉注射进行镇静，并持续输注丙泊酚维持。评估操作的难易程度和患者耐受性。次要结局包括患者和内镜医师满意度、苏醒总时间以及再次接受该检查的意愿。
结果
170例患者（平均年龄50.5岁，41.2%为男性）被随机分为两组（C组 = 85例，I组 = 85例；干预组）。两组患者中，100%的操作“成功”。C组中，98.8%的患者对其耐受程度（舒适度）满意，而I组为100%。C组再次接受检查的意愿评分为6.2±1.6，而I组为9.4±0.8。I组患者和内镜医师的满意度高于C组（分别为90.6%对35.3%和81.2%对40.0%）（p < 0.001）。I组中，丙泊酚总量为91.6±45.5mg，苏醒总时间为8.2±4.2分钟。使用镇静是患者满意度的主要决定因素，但会导致恢复室时间延长。C组中高血压和心动过速是最常见的并发症，I组中低血压是最常见的并发症。
结论
在泰国成年人群中，镇静下的诊断性EGD是提高内镜医师满意度和再次检查意愿的良好策略。
Zotero 插件