Jokelainen Jarno, Udd Marianne, Kylänpää Leena, Mustonen Harri, Halttunen Jorma, Lindström Outi, Pöyhiä Reino
a Department of Anesthesia and Intensive Care Medicine , Helsinki University Central Hospital, Helsinki Finland , Haartmaninkatu 4 , Helsinki , Finland.
b Department of Gastroenterological and General Surgery , Helsinki University Central Hospital , Helsinki , Finland.
Scand J Gastroenterol. 2017 Feb;52(2):166-172. doi: 10.1080/00365521.2016.1242024. Epub 2016 Oct 31.
Patient-controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large-scale studies are lacking.
A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting. All 956 patients undergoing 1196 ERCPs in the endoscopy unit of Helsinki University Central Hospital 2012-2013, methods of sedation and adverse events associated with different sedations were recorded.
PCS was attempted a total of 685 times (57%), successful use of PCS was achieved with 526 patients (77% of attempts). PCS device was operated by the anesthesiologist or anesthesia nurse 268 times (22%). PCS was more likely chosen for younger (80.6% for < =60 years vs. 63.8% for >60 years, p<.001) patients and by trainee anesthetists. Anesthesiologist administered propofol sedation was used 240 times (20%). The risk of failure of PCS was increased, if systolic arterial pressure was <90 mmHg, dosage of PCS >17 ml, duration of procedure exceeded 23 min. The risk of failure was lower in patients with primary sclerosing cholangitis (PSC) and if sedation was deeper RASS < =-2. Uneventful PCS was associated with less respiratory and cardiovascular depression than other methods. There were no statistically significant differences in safety profiles with all the methods of sedation.
PCS is readily implemented in clinical practice, is suitable for younger and low-risk patients and is associated with less cardiorespiratory adverse effects.
在随机研究中，患者自控镇静（PCS）已被证明是内镜逆行胰胆管造影（ERCP）期间镇静的有效选择。然而，缺乏大规模研究。
一项单中心前瞻性观察性研究，以确定在临床环境中如何进行ERCP镇静。2012年至2013年，在赫尔辛基大学中心医院内镜科接受1196例ERCP的所有956例患者，记录了镇静方法及与不同镇静相关的不良事件。
共尝试PCS 685次（57%），526例患者成功使用PCS（占尝试次数的77%）。PCS设备由麻醉医生或麻醉护士操作268次（22%）。年轻患者（≤60岁者为80.6%，>60岁者为63.8%，p<0.001）和实习麻醉医生更倾向于选择PCS。麻醉医生给予丙泊酚镇静240次（20%）。如果收缩压<90 mmHg、PCS剂量>17 ml、手术时间超过23分钟，PCS失败的风险会增加。原发性硬化性胆管炎（PSC）患者失败风险较低，且镇静深度为RASS≤ -2时失败风险也较低。与其他方法相比，平稳的PCS与较少的呼吸和心血管抑制相关。所有镇静方法的安全性方面无统计学显著差异。
PCS在临床实践中易于实施，适用于年轻和低风险患者，且与较少的心肺不良反应相关。
