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护士在内镜检查中实施的丙泊酚镇静

[Propofol sedation administered by nurses for endoscopic procedures].

作者信息

Vilmann Peter, Hornslet Pernille, Simmons Hanne, Hammering Anne, Clementsen Paul

机构信息

Gentofte Hospital, Kirurgisk Gastroenterologisk Afdeling, DK-2900 Hellerup.

出版信息

Ugeskr Laeger. 2009 May 25;171(22):1840-3.

Abstract

INTRODUCTION

As an increasing number of therapeutic and diagnostic procedures are performed endoscopically, the demand for sufficient sedation during endoscopy is rising. Propofol sedation administered by nurses (NAPS) has gained increasing popularity. NAPS was introduced at Gentofte Hospital in September 2007 after structured training at Roque Valley Surgical Center in Medford, Oregon, USA. The aim of the present study is to present our results with NAPS.

MATERIAL AND METHODS

Patients referred for endoscopy were monitored with regard to blood pressure, pulse oxymetry, electrocardiography and evaluation of their respiration during and after the procedure.

RESULTS

A total of 229 patients (233 endoscopic procedures) were included (ASA I: 68 (29%), ASA II: 116 (50%), ASA III: 44 (19%), ASA IV: 1 (0.4%)). The median propofol administration was 330 mg (variance 100-1,700 mg). Hypoxia, defined as oxygen < 92%, was observed in 18 patients. The hypoxia lasted less than 30 seconds in eight patients and between 30-60 seconds in eight cases. Two patients had hypoxia for a period exceeding 60 seconds. Propofol administration was discontinued in all 18 cases and increased oxygen flow was administered via a nasal tube. Short lasting manual mask ventilation was instituted in five patients. No serious events related to sedation were seen.

CONCLUSIONS

NAPS seem to be a suitable method for sedation in endoscopy and should be implemented in Denmark. However, proper training is required in collaboration with anaesthesiologists.

摘要

引言

随着越来越多的治疗和诊断程序通过内镜进行,内镜检查期间对充分镇静的需求不断增加。护士实施的丙泊酚镇静(NAPS)越来越受欢迎。2007年9月,在美国俄勒冈州梅德福的罗克谷外科中心接受结构化培训后,NAPS在根措夫特医院引入。本研究的目的是展示我们使用NAPS的结果。

材料与方法

对接受内镜检查的患者在检查期间及检查后进行血压、脉搏血氧饱和度、心电图监测以及呼吸评估。

结果

共纳入229例患者(233例内镜检查)(美国麻醉医师协会分级I级:68例(29%),II级:116例(50%),III级:44例(19%),IV级:1例(0.4%))。丙泊酚的中位用量为330毫克(范围100 - 1700毫克)。18例患者出现低氧血症,定义为氧饱和度<92%。8例患者低氧血症持续时间少于30秒,8例患者持续30 - 60秒。2例患者低氧血症持续时间超过60秒。所有18例患者均停用丙泊酚,并通过鼻导管增加氧流量。5例患者进行了短暂的手动面罩通气。未观察到与镇静相关的严重事件。

结论

NAPS似乎是内镜检查镇静的一种合适方法,应在丹麦推广。然而,需要与麻醉医生合作进行适当培训。

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