Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
J Gastroenterol Hepatol. 2012 Nov;27(11):1726-32. doi: 10.1111/j.1440-1746.2012.07231.x.
People with cirrhosis are at increased risk of development of complications related to sedation. The aim of the present study was to compare the effects of sedation for upper gastrointestinal endoscopy (UGIE) with propofol and midazolam on psychometric tests and critical flicker frequency (CFF) in people with cirrhosis.
A total of 127 people with cirrhosis were randomized into three groups: propofol group (n = 40), midazolam group (n = 42) and no sedation (n = 45). All patients underwent CFF test and combination of psychometry (number connection test-A and B [NCT-A,B]; digit symbol test [DST], line tracing test [LTT] and serial dotting test [SDT]) at baseline and at 2 h post-endoscopy. CFF was done at 30 min and repeated every 30 min for 2 h.
In the propofol group there was no deterioration in psychometry (NCT-A [55.6 ± 18.7 vs 56.4 ± 19.0 s], NCT-B [98.2 ± 35.1 vs 97.8 ± 34.6 s], DST [26.7 ± 5.7 vs 26.3 ± 5.3], LTT [112.9 ± 35.7 vs 113.7 ± 36.6 s], SDT [94.6 ± 34.1 vs 95.2 ± 34.5 s]). Significant deterioration from baseline (39.8 ± 2.9 Hz) was seen in CFF at 30 min (38.8 ± 2.3 Hz) and 1 h (39.2 ± 2.4 Hz), P = 0.01 but no difference thereafter. In the midazolam group, significant deterioration was observed on psychometry (NCT-A [56.0 ± 18.5 vs 60.4 ± 19.8 s], NCT-B [99.9 ± 29.1 vs 105.9.6 ± 30.3 s], DST [26.1 ± 4.7 vs 25.2 ± 4.3], LTT [129.1 ± 34.5 vs 132.9 ± 35.4 s], SDT [95.6 ± 34.2]). No deterioration was observed in psychometry and CFF in people with cirrhosis without sedation.
Propofol sedation for UGIE was associated with earlier recovery compared with midazolam, which causes deterioration of psychometric tests and CFF for a longer time in comparison with propofol.
肝硬化患者发生与镇静相关并发症的风险增加。本研究的目的是比较丙泊酚和咪达唑仑镇静对上消化道内镜（UGIE）的影响，以及它们对肝硬化患者的心理计量测试和临界闪烁频率（CFF）的影响。
共 127 名肝硬化患者随机分为三组：丙泊酚组（n=40）、咪达唑仑组（n=42）和无镇静组（n=45）。所有患者均在基线和内镜后 2 小时进行 CFF 测试和心理计量测试（数字连接测试 A 和 B[NCT-A，B]；数字符号测试[DST]、连线测试[LTT]和连续打点测试[SDT]）。CFF 在 30 分钟时进行，并在接下来的 2 小时内每 30 分钟重复一次。
在丙泊酚组中，心理计量测试（NCT-A[55.6±18.7 vs 56.4±19.0 s]、NCT-B[98.2±35.1 vs 97.8±34.6 s]、DST[26.7±5.7 vs 26.3±5.3]、LTT[112.9±35.7 vs 113.7±36.6 s]、SDT[94.6±34.1 vs 95.2±34.5 s]）没有恶化。CFF 在 30 分钟（38.8±2.3 Hz）和 1 小时（39.2±2.4 Hz）时明显低于基线（39.8±2.9 Hz），P=0.01，但此后无差异。在咪达唑仑组，心理计量测试（NCT-A[56.0±18.5 vs 60.4±19.8 s]、NCT-B[99.9±29.1 vs 105.9.6±30.3 s]、DST[26.1±4.7 vs 25.2±4.3]、LTT[129.1±34.5 vs 132.9±35.4 s]、SDT[95.6±34.2 s]）有明显恶化。未接受镇静的肝硬化患者的心理计量测试和 CFF 无恶化。
与咪达唑仑相比，丙泊酚镇静用于 UGIE 可更早恢复，而咪达唑仑引起的心理计量测试和 CFF 恶化时间比丙泊酚更长。
