Chen Yongpeng, Lu Yi, Xiang Xueyuan, Fu Liping, Liu Yanan, Li Chujun, Sun Jiachen
Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Front Pharmacol. 2023 Jul 10;14:1150045. doi: 10.3389/fphar.2023.1150045. eCollection 2023.
Colonoscopy plays an important role in the diagnosis, prognosis prediction, assessment of disease activity and severity, and treatment of inflammatory bowel disease (IBD)-related complications. However, some patients refuse to undergo colonoscopy due to perceived pain and other discomfort, their diagnosis and treatment are affected. Therefore, we conducted a prospective study to explore the efficacy and safety of midazolam combined with dezocine for sedation in IBD patients undergoing colonoscopy. 224 patients were divided into sedative-colonoscopy-group (SCG, n = 93), anesthesia-colonoscopy-group (ACG, n = 90) and ordinary-colonoscopy-group (OCG, n = 41). The vital signs (blood pressure, pulse, respiration and blood oxygen saturation), pain degree during colonoscopy, satisfaction and complication rates of the three groups were compared. Before colonoscopy, there was no significant difference among the vital signs of the three groups. The vital signs of the ACG were significantly lower than those of the SEG and the OCG ( < 0.05), and the difference was not significant between the SCG and OCG during colonoscopy. The colonoscopy pain score in the SCG was lower than that in the OCG (0.79 ± 1.09 vs. 2.98 ± 1.27, < 0.001). The satisfaction score of the SCG (9.26 ± 1.16) was not significantly different from that of the ACG (9.42 ± 1.41) but was higher than that of the OCG (6.63 ± 1.13) ( < 0.001). The total complication rate of the ACG was 45.56% (41/90), which was significantly higher than that of the SCG [20.43% (19/93)] and the OCG [19.51% (8/41)]. Colon perforation, abnormal blood pressure fluctuation and hypoxemia were significantly more common in the ACG than in the SCG and the OCG ( < 0.05). However, there was no significant difference in the incidence of complications between the SCG and OCG. Compared with ordinary-colonoscopy, colonoscopy performed under midazolam and dezocine sedation is more comfortable for patients, thereby increasing satisfaction and compliance. Colonoscopy that is performed under midazolam and dezocine is similar to colonoscopy that is anesthesia with propofol in terms of comfort, satisfaction and compliance and similar to ordinary-colonoscopy in terms of safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine for digestive endoscopy is worthy of clinical promotion.
结肠镜检查在炎症性肠病(IBD)相关并发症的诊断、预后预测、疾病活动度和严重程度评估以及治疗中发挥着重要作用。然而,一些患者因感觉到疼痛和其他不适而拒绝接受结肠镜检查,这影响了他们的诊断和治疗。因此,我们进行了一项前瞻性研究,以探讨咪达唑仑联合地佐辛用于IBD患者结肠镜检查镇静的有效性和安全性。224例患者分为镇静结肠镜检查组(SCG,n = 93)、麻醉结肠镜检查组(ACG,n = 90)和普通结肠镜检查组(OCG,n = 41)。比较了三组患者的生命体征(血压、脉搏、呼吸和血氧饱和度)、结肠镜检查期间的疼痛程度、满意度和并发症发生率。结肠镜检查前,三组患者的生命体征无显著差异。ACG组的生命体征显著低于SEG组和OCG组(<0.05),结肠镜检查期间SCG组和OCG组之间差异不显著。SCG组的结肠镜检查疼痛评分低于OCG组(0.79±1.09 vs. 2.98±1.27,<0.001)。SCG组的满意度评分(9.26±1.16)与ACG组(9.42±1.41)无显著差异,但高于OCG组(6.63±1.13)(<0.001)。ACG组的总并发症发生率为45.56%(41/90),显著高于SCG组[20.43%(19/93)]和OCG组[19.51%(8/41)]。ACG组的结肠穿孔、血压异常波动和低氧血症明显比SCG组和OCG组更常见(<0.05)。然而,SCG组和OCG组之间的并发症发生率无显著差异。与普通结肠镜检查相比,咪达唑仑和地佐辛镇静下的结肠镜检查对患者来说更舒适,从而提高了满意度和依从性。咪达唑仑和地佐辛镇静下的结肠镜检查在舒适度、满意度和依从性方面与丙泊酚麻醉的结肠镜检查相似,在安全性方面与普通结肠镜检查相似。考虑到麻醉医生短缺,咪达唑仑联合地佐辛在消化内镜检查中的应用值得临床推广。