Schilling D, Rosenbaum A, Schweizer S, Richter H, Rumstadt B
Department of Gastroenterology and Interventional Endoscopy, Diakonie Hospital Mannheim, Germany.
Endoscopy. 2009 Apr;41(4):295-8. doi: 10.1055/s-0028-1119671. Epub 2009 Apr 1.
Sedation with the short-acting anesthetic agent propofol has shown several advantages, particularly in interventional endoscopy. So far, however, there are no valid data on the safety of nurse-administered propofol sedation (NAPS) during interventional endoscopy in elderly high-risk patients.
A total of 150 patients aged > 80 years with high comorbidity were randomized to receive midazolam plus meperidine (n = 75) or propofol alone (n = 76) for sedation during endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), or double-balloon endoscopy (DBE). Sedation was supervised by a trained nurse and a trained physician both of whom were not involved in the endoscopic procedure. Vital signs were continuously monitored as well as patient cooperation and tolerance. Mortality and morbidity at 30 days was analyzed.
The overall cardiopulmonary complication rate was 16 % in the midazolam group and 23.7 % in the propofol group ( P > 0.05). The mean decline in oxygen saturation (initial vs. lowest O (2) saturation) and the mean decline of blood pressure (initial vs. lowest blood pressure) were significantly greater with propofol (7 % +/- 3 % vs. 4 % +/- 2 % [ P < 0.05] and 10 % +/- 2 % vs. 8 % +/- 2 %, respectively [ P < 0.05]). No procedure had to be interrupted due to serious adverse events. Patient cooperation was statistically significantly better in the propofol group (7 +/- 2 vs. 5 +/- 2 points). Patients sedated with propofol showed a significantly lower oxygen saturation rate during recovery time (8 % vs. 28 %; P < or = 0.01).
NAPS during interventional endoscopy is as safe as midazolam/pethidine sedation even in high-risk patients aged > 80 years.
使用短效麻醉剂丙泊酚进行镇静已显示出多种优势，尤其是在介入性内镜检查中。然而，迄今为止，尚无关于老年高危患者介入性内镜检查期间护士给予丙泊酚镇静（NAPS）安全性的有效数据。
总共150例年龄大于80岁且合并症严重的患者被随机分配，在内镜逆行胰胆管造影（ERCP）、内镜超声检查（EUS）或双气囊内镜检查（DBE）期间，接受咪达唑仑加哌替啶（n = 75）或仅接受丙泊酚（n = 76）进行镇静。镇静由一名经过培训的护士和一名经过培训的医生监督，他们均未参与内镜操作。持续监测生命体征以及患者的配合度和耐受性。分析30天内的死亡率和发病率。
咪达唑仑组的总体心肺并发症发生率为16%，丙泊酚组为23.7%（P>0.05）。丙泊酚组的平均氧饱和度下降（初始与最低O₂饱和度）和平均血压下降（初始与最低血压）明显更大（分别为7%±3%对4%±2%[P<0.05]和10%±2%对8%±2%，[P<0.05]）。没有因严重不良事件而中断任何操作。丙泊酚组患者的配合度在统计学上明显更好（7±2分对5±2分）。使用丙泊酚镇静的患者在恢复期间的氧饱和度明显较低（8%对28%；P≤0.01）。
即使在年龄大于80岁的高危患者中，介入性内镜检查期间的NAPS与咪达唑仑/哌替啶镇静一样安全。
