Lieberman D A, Wuerker C K, Katon R M
Gastroenterology. 1985 Feb;88(2):468-72. doi: 10.1016/0016-5085(85)90508-6.
The impact of endoscope diameter and the presence of systemic sedation on the cardiopulmonary risk of esophagogastroduodenoscopy was investigated. One hundred and forty-six patients undergoing elective esophagogastroduodenoscopy were randomly assigned to one of three groups which differed in either endoscope diameter or use of sedation: group 1 (8.5-mm endoscope with no sedation), group 2 (8.5-mm endoscope with diazepam), and group 3 (11.5-mm endoscope with diazepam). Esophagogastroduodenoscopy was tolerated best by group 2, and this group had the fewest electrocardiographic changes observed on a Holter recording during esophagogastroduodenoscopy. The incidence of electrocardiographic changes during esophagogastroduodenoscopy correlated with patient tolerance (p less than 0.001) and the use of the smaller endoscope (p less than 0.05). The most common arrhythmia was sinus tachycardia (49 patients), but more serious electrocardiographic changes were observed in 21 patients. Serious arrhythmias were more common in patients with a prior history of cardiovascular disease compared with patients with no such history (30% vs. 6%, p less than 0.001). Arterial oxygen desaturation (measured by ear oximetry) during intubation and esophagogastroduodenoscopy was usually modest (2%-5%). However, 16 patients receiving diazepam experienced high levels of desaturation exceeding 7%; this small group of patients also experienced more electrocardiographic changes than other patients. The use of diazepam sedation and an 8.5-mm endoscope may offer the safest and most comfortable combination for most patients undergoing esophagogastroduodenoscopy. Diazepam sedation, however, may represent a potential danger to a small number of patients with marginal baseline arterial saturation.
研究了内镜直径和全身镇静对食管胃十二指肠镜检查心肺风险的影响。146例接受择期食管胃十二指肠镜检查的患者被随机分为三组，每组在内镜直径或镇静使用方面有所不同：第1组（使用8.5毫米内镜且未使用镇静剂），第2组（使用8.5毫米内镜并使用地西泮），第3组（使用11.5毫米内镜并使用地西泮）。第2组对食管胃十二指肠镜检查的耐受性最佳，且该组在食管胃十二指肠镜检查期间动态心电图记录中观察到的心电图变化最少。食管胃十二指肠镜检查期间心电图变化的发生率与患者耐受性相关（p<0.001），也与使用较小直径的内镜相关（p<0.05）。最常见的心律失常是窦性心动过速（49例患者），但在21例患者中观察到了更严重的心电图变化。与无心血管疾病病史的患者相比，有心血管疾病病史的患者发生严重心律失常更为常见（30%对6%，p<0.001）。插管和食管胃十二指肠镜检查期间的动脉血氧饱和度下降（通过耳部血氧测定法测量）通常较轻（2%-5%）。然而，16例接受地西泮治疗的患者出现了超过7%的高度血氧饱和度下降；这一小部分患者的心电图变化也比其他患者更多。对于大多数接受食管胃十二指肠镜检查的患者，使用地西泮镇静和8.5毫米内镜可能提供最安全、最舒适的组合。然而，地西泮镇静可能对少数基线动脉血氧饱和度临界的患者构成潜在危险。
