Gastroenterology Associates of Central Jersey, Edison, NJ, USA.
Dig Dis Sci. 2010 Sep;55(9):2537-44. doi: 10.1007/s10620-010-1308-0. Epub 2010 Jul 16.
The purposes of this study are: (1) to prospectively evaluate clinically relevant outcomes including sedation-related complications for endoscopic ultrasound (EUS) procedures performed with the use of propofol deep sedation administered by monitored anesthesia care (MAC), and (2) to compare these results with a historical case-control cohort of EUS procedures performed using moderate sedation provided by the gastrointestinal (GI) endoscopist.
Patients referred for EUS between January 1, 2001 and December 31, 2002 were enrolled. Complication rates for EUS using MAC sedation were observed and also compared with a historical case-control cohort of EUS patients who received meperidine/midazolam for moderate sedation, administered by the GI endoscopist. Logistic regression analysis was used to isolate possible predictors of complications.
A total of 1,000 patients underwent EUS with propofol sedation during the period from January 1, 2001 through December 31, 2002 (mean age 64 years, 53% female). The distribution of EUS indications based on the primary area of interest was: 170 gastroduodenal, 92 anorectal, 508 pancreaticohepatobiliary, 183 esophageal, and 47 mediastinal. The primary endpoint of the study was development of sedation-related complications occurring during a performed procedure. A total of six patients experienced complications: duodenal perforation (one), hypotension (one), aspiration pneumonia (one), and apnea requiring endotracheal intubation (three). The complication rate with propofol was 0.60%, compared with 1% for the historical case-control (meperidine/midazolam moderate sedation) group.
There does not appear to be a significant difference between complication rates for propofol deep sedation with MAC and meperidine/midazolam administered for moderate sedation.
本研究的目的是：（1）前瞻性评估包括镇静相关并发症在内的临床相关结局，这些并发症与使用监测麻醉护理（MAC）下的异丙酚深镇静进行的内镜超声（EUS）程序有关；（2）将这些结果与使用胃肠（GI）内镜医生提供的中度镇静的 EUS 程序的历史病例对照队列进行比较。
招募了 2001 年 1 月 1 日至 2002 年 12 月 31 日期间接受 EUS 的患者。观察使用 MAC 镇静进行 EUS 的并发症发生率，并与接受 GI 内镜医生给予的哌替啶/咪达唑仑进行中度镇静的 EUS 患者的历史病例对照队列进行比较。使用逻辑回归分析来分离并发症的可能预测因素。
在 2001 年 1 月 1 日至 2002 年 12 月 31 日期间，共有 1000 例患者接受了 EUS 检查，使用了异丙酚镇静（平均年龄 64 岁，53%为女性）。根据主要关注领域，EUS 指征的分布如下：170 例胃十二指肠、92 例肛门直肠、508 例胰胆肝、183 例食管和 47 例纵隔。本研究的主要终点是在进行的程序中发生与镇静相关的并发症。共有 6 例患者出现并发症：十二指肠穿孔（1 例）、低血压（1 例）、吸入性肺炎（1 例）和需要气管插管的呼吸暂停（3 例）。使用异丙酚的并发症发生率为 0.60%，而历史病例对照（哌替啶/咪达唑仑中度镇静）组为 1%。
使用 MAC 下的异丙酚深镇静与哌替啶/咪达唑仑进行中度镇静的并发症发生率似乎没有显著差异。
