在接受诊断性上消化道内镜检查的成年患者中使用舌下或口服阿普唑仑进行术前用药。

Premedication with sublingual or oral alprazolam in adults undergoing diagnostic upper gastrointestinal endoscopy.

作者信息

Shavakhi Ahmad, Soleiman Soghry, Gholamrezaei Ali, Khodadoostan Mahsa, Shavakhi Sara, Tahery Abdolmajid, Minakari Mohammad

机构信息

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Poursina Hakim Research Institution, Isfahan, Iran.

出版信息

Endoscopy. 2014 Aug;46(8):633-9. doi: 10.1055/s-0034-1377305. Epub 2014 Jun 30.

DOI:10.1055/s-0034-1377305

PMID:24977401

Abstract

BACKGROUND AND STUDY AIM

Diagnostic esophagogastroduodenoscopy (EGD) is uncomfortable for most patients. We determined the efficacy of alprazolam, administered orally or sublingually, as premedication for sedation during EGD.

PATIENTS AND METHODS

Adult EGD candidates were randomly allocated to four groups (n = 55, each group) and received alprazolam (0.5 mg) sublingually or orally, placebo sublingually or orally at 30 minutes before EGD. Main outcome measures included procedure-related anxiety and pain/discomfort (assessed using 11-point numeric scales), patient overall tolerance (assessed using a 4-point Likert scale), need for intravenous sedation, and willingness to repeat the EGD if necessary.

RESULTS

Patients experienced greater reduction in anxiety score after medication with sublingual alprazolam (mean 2.25, standard deviation [SD] 1.73) compared with sublingual placebo (mean 0.10, standard error [SE] 0.15]; P < 0.001) and oral alprazolam (0.63, SE 0.14; P < 0.001). Also, pain/discomfort scores were lower with sublingual alprazolam compared with sublingual placebo (3.29, SE 0.29 vs. 4.16, SD 1.86; P = 0.024), and with oral alprazolam compared with oral placebo (3.48, SD 1.69 vs. 5.13, SD 2.39; P < 0.001). Patient overall tolerance was better with sublingual alprazolam than with sublingual placebo (P = 0.005) or with oral alprazolam (P = 0.009). Regarding intravenous sedation, there was no difference between sublingual alprazolam and sublingual placebo (10.9 % vs. 10.9 %; P = 0.619) or between oral alprazolam and oral placebo (9.0 % vs. 12.7 %; P = 0.381). Willingness to repeat the procedure was greater with sublingual alprazolam than with sublingual placebo (50.9 % vs. 30.9 %; P = 0.026).

CONCLUSIONS

Sublingual alprazolam is an effective premedication for sedation during EGD. It reduces anxiety and pain/discomfort related to EGD and increases patient tolerance and willingness to repeat the EGD if necessary.

CLINICAL TRIAL REGISTRATION

NCT01949038 ClinicalTrials.gov.

摘要

背景与研究目的

诊断性食管胃十二指肠镜检查（EGD）对大多数患者来说都不舒服。我们确定了口服或舌下含服阿普唑仑作为EGD镇静预处理药物的疗效。

患者与方法

成年EGD候选患者被随机分为四组（每组n = 55），在EGD前30分钟接受舌下或口服阿普唑仑（0.5毫克）、舌下或口服安慰剂。主要观察指标包括与操作相关的焦虑和疼痛/不适（使用11分数字量表评估）、患者总体耐受性（使用4分李克特量表评估）、静脉镇静的需求以及必要时重复进行EGD的意愿。

结果

与舌下含服安慰剂（平均0.10，标准误[SE] 0.15；P < 0.001）和口服阿普唑仑（0.63，SE 0.14；P < 0.001）相比，舌下含服阿普唑仑用药后患者焦虑评分降低幅度更大。此外，与舌下含服安慰剂（3.29，SE 0.29对4.16，标准差[SD] 1.86；P = 0.024）以及与口服阿普唑仑相比（3.48，SD 1.69对5.13，SD 2.39；P < 0.001），舌下含服阿普唑仑的疼痛/不适评分更低。舌下含服阿普唑仑的患者总体耐受性优于舌下含服安慰剂（P = 0.005）或口服阿普唑仑（P = 0.009）。关于静脉镇静，舌下含服阿普唑仑与舌下含服安慰剂之间无差异（10.9%对10.9%；P = 0.619），口服阿普唑仑与口服安慰剂之间也无差异（9.0%对12.7%；P = 0.381）。与舌下含服安慰剂相比，舌下含服阿普唑仑患者重复进行该操作的意愿更高（50.9%对30.9%；P = 0.026）。