Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Dig Endosc. 2014 Nov;26(6):701-6. doi: 10.1111/den.12342. Epub 2014 Sep 29.
Propofol has been suggested to be superior to benzodiazepines when used as a sedative agent for endoscopic examination. The aim of the present study was to systematically evaluate the safety and efficacy of propofol sedation for endoscopic submucosal dissection (ESD).
PubMed, the Cochrane library, and the Igaku-Chuo-Zasshi database were searched in order to identify randomized trials eligible for inclusion in the systematic review. Data from the eligible studies were combined to calculate pooled odds ratios (OR) of developing restlessness, full awakening at 1 h post-ESD, hypoxia, and hypotension.
We identified three randomized trials (298 patients) from the database search. Compared with traditional sedative agents, the pooled OR of restlessness and full awakening at 1 h post-ESD with propofol sedation were 0.41 (95% confidence interval [CI]: 0.21-0.81) and 8.59 (95% CI: 4.29-17.2), respectively, without significant heterogeneity. Compared with traditional sedative agents, the pooled OR of hypoxia and hypotension with propofol sedation were 1.13 (95% CI: 0.58-2.21) and 0.92 (95% CI: 0.25-3.41), respectively, indicating no significant differences between the groups.
Propofol sedation during ESD is more effective as compared with traditional sedative agent. The risk of complications is similar.
在作为内镜检查的镇静剂时，丙泊酚被认为优于苯二氮䓬类药物。本研究旨在系统评估丙泊酚镇静在内镜黏膜下剥离术（ESD）中的安全性和有效性。
通过检索 PubMed、Cochrane 图书馆和 Igaku-Chuo-Zasshi 数据库，确定符合纳入标准的随机试验进行系统评价。对合格研究中的数据进行合并，以计算发生烦躁不安、ESD 后 1 小时完全清醒、缺氧和低血压的汇总比值比（OR）。
我们从数据库检索中确定了三项随机试验（298 例患者）。与传统镇静剂相比，丙泊酚镇静时发生烦躁不安和 ESD 后 1 小时完全清醒的汇总 OR 分别为 0.41（95%置信区间 [CI]：0.21-0.81）和 8.59（95% CI：4.29-17.2），无显著异质性。与传统镇静剂相比，丙泊酚镇静时发生缺氧和低血压的汇总 OR 分别为 1.13（95% CI：0.58-2.21）和 0.92（95% CI：0.25-3.41），组间差异无统计学意义。
与传统镇静剂相比，ESD 期间使用丙泊酚镇静更有效。并发症风险相似。
