Riphaus A, Rabofski M, Wehrmann T
Krankenhaus Siloah, Klinikum Region Hannover GmbH, Hannover.
Z Gastroenterol. 2010 Mar;48(3):392-7. doi: 10.1055/s-0028-1109765. Epub 2010 Feb 5.
The use of sedation (e. g., of short-acting propofol) for gastrointestinal endoscopy has shown an upward trend in the United States and Europe over the last decade. This survey aimed at providing nationwide data on the current practice of endoscopic sedation and monitoring in Germany.
A 21-item survey regarding current practices of endoscopy, sedation and monitoring in gastrointestinal endoscopy was sent to 3 802 members of the German Society of Digestive and Metabolic Diseases (DGVS).
A total of 1 061 / 3 802 (28%) questionnaires were returned. The respondents performed an average of 28 esophagogastro-duodenoscopies (EGDs) and 25 colonoscopies per week. Endoscopic procedures were staged in a hospital setting (60%) more often than in private practices (40%). The majority of the EGDs (74%) and colonoscopies (87%) were carried out under sedation, however, this fact may be influenced by a recall bias. The most frequently used agents for sedation were midazolam in 82% and propofol in 74% of the cases. The most common sedation regimens applied were propofol plus benzodiazepines (38%) and benzodiazepines with an opioid (35%). Patients were routinely monitored by pulse oximetry (97%), automated blood pressure readings (29%) and/or electrocardiography (13%). Supplemental oxygen was routinely administered in 34% of them. Endoscopists' satisfaction with sedation was greater among those using propofol than in the group applying benzodiazepines (visual analogue scale, 8.8 +/- 0.9 vs. 8.2 +/- 1.3, p < 0.0001).
Besides the common administration of short-acting benzodiazepines, sedation with propofol is also gaining ground in Germany; it is applied mainly in low doses (up to 150 mg). German endoscopists are highly satisfied with these sedation regimens, with propofol significantly leading the score. Patient monitoring predominantly follows currently prevailing guidelines.
在过去十年中，美国和欧洲使用镇静剂（如短效丙泊酚）进行胃肠内镜检查的情况呈上升趋势。本次调查旨在提供德国目前内镜镇静及监测实践的全国性数据。
向德国消化和代谢疾病学会（DGVS）的3802名成员发送了一份关于胃肠内镜检查中内镜检查、镇静及监测当前实践的21项调查问卷。
共收回1061份/3802份（28%）问卷。受访者每周平均进行28次食管胃十二指肠镜检查（EGD）和25次结肠镜检查。内镜检查在医院环境中进行的比例（60%）高于私人诊所（40%）。大多数EGD（74%）和结肠镜检查（87%）在镇静下进行，然而，这一事实可能受到回忆偏倚的影响。最常用的镇静剂是咪达唑仑，82%的病例使用，丙泊酚为74%。最常用的镇静方案是丙泊酚加苯二氮䓬类药物（38%）和苯二氮䓬类药物加阿片类药物（35%）。患者常规接受脉搏血氧饱和度监测（97%）、自动血压读数监测（29%）和/或心电图监测（13%）。其中34%的患者常规给予补充氧气。使用丙泊酚的内镜医师对镇静的满意度高于使用苯二氮䓬类药物的组（视觉模拟评分，8.8±0.9对8.2±1.3，p<0.0001）。
除了常用的短效苯二氮䓬类药物给药外，丙泊酚镇静在德国也越来越普遍；主要以低剂量（高达150mg）使用。德国内镜医师对这些镇静方案高度满意，丙泊酚得分显著领先。患者监测主要遵循当前流行的指南。
