Department of HPB Surgery, Frimley Park Hospital National Health Service (NHS) Foundation Trust, Frimley, UK.
HPB (Oxford). 2011 Mar;13(3):174-7. doi: 10.1111/j.1477-2574.2010.00266.x. Epub 2011 Jan 25.
Historically, hepatopancreatobiliary surgeons and gastroenterologists have undertaken endoscopic retrograde cholangiopancreatography (ERCP) using benzodiazepine sedation (BS). This is poorly tolerated by a substantial number of patients, which leads to its potential premature abandonment and subsequent additional investigations and therapeutics, and hence to the exposure of patients to avoidable risk and the health service to increased costs. Furthermore, concerns have been raised in the recent literature regarding safe sedation techniques.
The aim of this study was to compare the completion rates and safety profile of ERCP using BS vs. those of ERCP using light propofol anaesthesia (PA).
We carried out a retrospective, case-matched comparison analysis of consecutive patients who underwent ERCP with BS vs. PA, in the presence of an anaesthetist, over a 2-year period. Benzodiazepine sedation consisted of midazolam, fentanyl and buscopan. Propofol anaesthesia consisted of propofol, fentanyl and buscopan administered via a mouth guard in a non-intubated patient. Patient demographics, complications and completion rates were recorded. Procedural monitoring included pulse oximetry, non-invasive blood pressure, electrocardiography and end-tidal CO(2) . Statistical analyses used t-tests to compare continuous variables and chi-squared and Fisher's exact tests to compare categorical variables. A P-value of <0.05 was considered significant.
Of 252 patients included in the study, 128 (50.8%) received BS and 124 (49.2%) received PA. Median ages in the BS and PA groups were 69 years (range: 20-99 years) and 65 years (range: 26-98 years), respectively (P= 0.07). Median hospital stays in the BS and PA groups were 1 day (range: day case to 61 days) and 1 day (range: day case to 38 days), respectively (P= 0.61). Incidences of mild anaesthesia-related complications in the BS and PA groups were 2.3% and 2.4%, respectively (P= 0.97). There were no severe anaesthesia-related complications. Incidences of mild procedural complications in the BS and PA groups were 2.3% and 1.6%, respectively (P= 0.68). One severe procedural complication occurred in the PA group. Incidences of incomplete ERCP procedures in the BS and PA groups were 10.9% (n= 14) and 4.0% (n= 5), respectively (odds ratio = 2.92, 95% confidence interval 1.02-8.38; chi-squared test, P= 0.04; Fisher's exact test, P= 0.03).
Propofol anaesthesia for ERCP carried out in the presence of an anaesthetist is safe and may improve procedural completion rates.
历史上，肝胆胰外科学家和胃肠病学家在使用苯二氮䓬类镇静剂 (BS) 进行内镜逆行胰胆管造影术 (ERCP)。 相当数量的患者对此类镇静剂耐受性差，这导致其可能被过早放弃，随后需要进行额外的检查和治疗，从而使患者面临可避免的风险，并使医疗服务增加成本。 此外，最近的文献中也提出了对安全镇静技术的担忧。
本研究旨在比较使用 BS 与使用轻丙泊酚麻醉 (PA) 进行 ERCP 的完成率和安全性。
我们进行了一项回顾性、病例匹配的比较分析，比较了在麻醉师在场的情况下，在 2 年内连续接受 BS 或 PA 治疗的 ERCP 患者。BS 镇静包括咪达唑仑、芬太尼和布托啡诺。PA 镇静包括丙泊酚、芬太尼和布托啡诺，通过口内护齿器给药，用于非插管患者。记录患者的人口统计学、并发症和完成率。程序监测包括脉搏血氧饱和度、无创血压、心电图和呼气末 CO2。统计学分析使用 t 检验比较连续变量，使用卡方检验和 Fisher 确切概率法比较分类变量。P 值<0.05 被认为具有统计学意义。
在纳入的 252 例患者中，128 例（50.8%）接受 BS 治疗，124 例（49.2%）接受 PA 治疗。BS 和 PA 组的中位年龄分别为 69 岁（范围：20-99 岁）和 65 岁（范围：26-98 岁）（P=0.07）。BS 和 PA 组的中位住院时间分别为 1 天（范围：门诊至 61 天）和 1 天（范围：门诊至 38 天）（P=0.61）。BS 和 PA 组轻度麻醉相关并发症的发生率分别为 2.3%和 2.4%（P=0.97）。无严重麻醉相关并发症。BS 和 PA 组轻度手术相关并发症的发生率分别为 2.3%和 1.6%（P=0.68）。PA 组发生 1 例严重手术相关并发症。BS 和 PA 组不完全 ERCP 手术的发生率分别为 10.9%（n=14）和 4.0%（n=5）（比值比=2.92，95%置信区间 1.02-8.38；卡方检验，P=0.04；Fisher 确切概率法，P=0.03）。
在麻醉师在场的情况下使用丙泊酚进行 ERCP 是安全的，并且可能提高手术完成率。
