Barriga Jose, Sachdev Mankanwal S, Royall Lee, Brown Garrick, Tombazzi Claudio R
Division of Gastroenterology, Department of Medicine, University of Tennessee, Memphis, TN 38163, USA.
South Med J. 2008 Apr;101(4):362-6. doi: 10.1097/SMJ.0b013e318168521b.
The benefit of using one or two drugs for conscious sedation in upper endoscopy remains unproven. This study evaluates the adequacy of conscious sedation during upper endoscopy using midazolam alone compared with midazolam plus fentanyl.
Patients older than 18 years of age who underwent elective, outpatient upper endoscopy were included. They were randomized to receive either a combination of midazolam/fentanyl or midazolam alone. The adequacy of sedation obtained was assessed using a questionnaire answered by the physician at the end of the procedure, and by the patient 24 to 72 hours after endoscopy.
From the endoscopist's perspective, following an intention-to-treat analysis, patients had better tolerance in the combination group (78.3% excellent/good tolerance M/F group versus 55.8% M group) (P = 0.043) (Table 2). Per patient's assessment excellent/good tolerance was found in 93% of M group and 94% in F/M group (P = 1.0). No difference in duration of the procedure was found between the two groups. No complications during endoscopies were reported.
In diagnostic upper endoscopy, an adequate level of sedation can be obtained safely either by midazolam or midazolam plus fentanyl. From an endoscopist's perspective, the combination is significantly better.
在上消化道内镜检查中使用一种或两种药物进行清醒镇静的益处尚未得到证实。本研究评估了单独使用咪达唑仑与咪达唑仑加芬太尼在上消化道内镜检查期间清醒镇静的充分性。
纳入年龄大于18岁、接受择期门诊上消化道内镜检查的患者。他们被随机分为接受咪达唑仑/芬太尼联合用药组或单独使用咪达唑仑组。使用医生在检查结束时填写的问卷以及患者在胃镜检查后24至72小时填写的问卷来评估所获得的镇静充分性。
从内镜医师的角度来看，在意向性分析之后，联合用药组患者的耐受性更好（联合用药组优秀/良好耐受性为78.3%，男性/女性组与单独使用咪达唑仑组的55.8%相比）（P = 0.043）（表2）。根据患者的评估，单独使用咪达唑仑组优秀/良好耐受性为93%，联合用药组为94%（P = 1.0）。两组之间的检查持续时间没有差异。内镜检查期间未报告并发症。
在诊断性上消化道内镜检查中，单独使用咪达唑仑或咪达唑仑加芬太尼均可安全地获得充分的镇静水平。从内镜医师的角度来看，联合用药明显更好。
