Bell G D, Spickett G P, Reeve P A, Morden A, Logan R F
Br J Clin Pharmacol. 1987 Feb;23(2):241-3. doi: 10.1111/j.1365-2125.1987.tb03037.x.
In many endoscopy units midazolam is replacing diazepam as the intravenous sedative of first choice. Midazolam is approximately twice as potent as diazepam. Although generally considered a safe drug, there have been a number of recent reports, particularly in the elderly, of the drug causing hypotension, respiratory depression and even death. There have been at least ten studies comparing diazepam with midazolam for upper gastrointestinal endoscopy but many have involved relatively small numbers and none have adequately addressed the question of dosage in the elderly. We have carefully recorded the dose of intravenous midazolam used to produce adequate sedation prior to upper gastrointestinal endoscopy in 800 consecutive patients. The dose of midazolam decreased markedly with age in both male and female patients. There was a highly significant correlation in both sexes between age and the dose of midazolam (rho -0.787, P less than 0.001 for males and rho -0.768, P less than 0.001 for females). There was only a small difference in dose in men and women, an average of 1 mg; and no difference in dose over the age of 70 years. In patients over 70 years of age the dose of midazolam necessary for endoscopy is often so small that overdosage is all too easy.
在许多内镜检查科室，咪达唑仑正取代地西泮成为首选的静脉镇静剂。咪达唑仑的效力约为地西泮的两倍。尽管通常被认为是一种安全的药物，但最近有许多报告，特别是在老年人中，称该药物会导致低血压、呼吸抑制甚至死亡。至少有十项研究比较了地西泮和咪达唑仑在上消化道内镜检查中的效果，但许多研究涉及的病例数相对较少，而且没有一项研究充分解决老年人的用药剂量问题。我们仔细记录了800例连续接受上消化道内镜检查的患者在检查前用于产生充分镇静效果的静脉注射咪达唑仑的剂量。男性和女性患者中，咪达唑仑的剂量均随年龄显著降低。在男性和女性中，年龄与咪达唑仑剂量之间均存在高度显著的相关性（男性：rho = -0.787，P < 0.001；女性：rho = -0.768，P < 0.001）。男性和女性的剂量差异很小，平均相差1毫克；70岁以上患者的剂量没有差异。在70岁以上的患者中，内镜检查所需的咪达唑仑剂量往往非常小，以至于过量用药非常容易发生。
