Kongkam Pradermchai, Rerknimitr Rungsun, Punyathavorn Sahadol, Sitthi-Amorn Chitr, Ponauthai Yuwadee, Prempracha Narongrit, Kullavanijaya Pinit
Division of Gastroenterology, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand.
J Gastrointestin Liver Dis. 2008 Sep;17(3):291-7.
ERCP generally requires longer time than standard endoscopy. Only few studies have shown benefit of intermittent propofol over conventional sedation. This study was conducted to compare satisfaction, recovery score, and recovery/safety profiles for ERCP sedation between continuous infusion of propofol and conventional sedation.
One hundred thirty-four patients with ASA I-III underwent ERCP and were randomly assigned into two groups (n=67 each). Patients underwent propofol sedation or meperidine/midazolam sedation. Supplemental oxygen was offered only when oxygen saturation was lower than 90 %. Oxygen saturation, blood pressure, heart rate, recovery score, times for recovery and satisfaction score after procedure were recorded and analyzed.
Average amount of meperidine, midazolam and propofol per each patient were 61.54 (+/- 27.29), 7.80 (+/- 3.73), 299.90 (+/- 146.15) mg, respectively. Time to regain full consciousness in the propofol arm was significantly shorter than in the conventional arm (17.24 +/- 5.99 versus 34.25 +/- 16.06 min, p<0.001). The rates of desaturation, bradycardia and hypotension in both arms were low and comparable. Propofol provided higher level of recovery scores at 15, 30, 45 and 60 min after the procedure (p < 0.001).
Continuous infusion of propofol for ERCP by direction of gastroenterologist yields no difference in the completion rate and adverse profiles when compared with conventional technique but it provides a better recovery profile. The maintainance of appropriate level of sedation by well trained personnel is the key to achieve this success.
内镜逆行胰胆管造影术（ERCP）通常比标准内镜检查需要更长时间。仅有少数研究表明间断使用丙泊酚比传统镇静方法更具优势。本研究旨在比较持续输注丙泊酚与传统镇静用于ERCP镇静时的满意度、恢复评分以及恢复/安全情况。
134例美国麻醉医师协会（ASA）分级为I-III级的患者接受了ERCP，并被随机分为两组（每组n = 67）。患者分别接受丙泊酚镇静或哌替啶/咪达唑仑镇静。仅当血氧饱和度低于90%时给予补充氧气。记录并分析血氧饱和度、血压、心率、恢复评分、术后恢复时间及满意度评分。
每位患者哌替啶、咪达唑仑和丙泊酚的平均用量分别为61.54（±27.29）、7.80（±3.73）、299.90（±146.15）mg。丙泊酚组患者完全清醒的时间显著短于传统镇静组（17.24±5.99分钟对34.25±16.06分钟，p<0.001）。两组的血氧饱和度降低、心动过缓和低血压发生率均较低且相当。丙泊酚在术后15、30、45和60分钟时提供了更高水平的恢复评分（p<0.001）。
在胃肠病学家指导下持续输注丙泊酚用于ERCP，与传统技术相比，在完成率和不良情况方面无差异，但恢复情况更好。由训练有素的人员维持适当的镇静水平是取得这一成功的关键。
