Froehlich F, Thorens J, Schwizer W, Preisig M, Köhler M, Hays R D, Fried M, Gonvers J J
Department of Gastroenterology, University Hospital, Lausanne, Switzerland.
Gastrointest Endosc. 1997 Jan;45(1):1-9. doi: 10.1016/s0016-5107(97)70295-5.
Colonoscopy is generally performed with the patient sedated and receiving analgesics. However, the benefit of the most often used combination of intravenous midazolam and pethidine on patient tolerance and pain and its cardiorespiratory risk have not been fully defined.
In this double-blind prospective study, 150 outpatients undergoing routine colonoscopy were randomly assigned to receive either (1) low-dose midazolam (35 micrograms/kg) and pethidine (700 micrograms/kg in 48 patients, 500 micrograms/kg in 102 patients), (2) midazolam and placebo pethidine, or (3) pethidine and placebo midazolam.
Tolerance (visual analog scale, 0 to 100 points: 0 = excellent; 100 = unbearable) did not improve significantly more in group 1 compared with group 2 (7 points; 95% confidence interval [-2-17]) and group 3 (2 points; 95% confidence interval [-7-12]). Similarly, pain was not significantly improved in group 1 as compared with the other groups. Male gender (p < 0.001) and shorter duration of the procedure (p = 0.004), but not amnesia, were associated with better patient tolerance and less pain. Patient satisfaction was similar in all groups. Oxygen desaturation and hypotension occurred in 33% and 11%, respectively, with a similar frequency in all three groups.
In this study, the combination of low-dose midazolam and pethidine does not improve patient tolerance and lessen pain during colonoscopy as compared with either drug given alone. When applying low-dose midazolam, oxygen desaturation and hypotension do not occur more often after combined use of both drugs. For the individual patient, sedation and analgesia should be based on the endoscopist's clinical judgement.
结肠镜检查通常在患者镇静并接受镇痛剂的情况下进行。然而，最常用的静脉注射咪达唑仑和哌替啶组合对患者耐受性、疼痛及其心肺风险的益处尚未完全明确。
在这项双盲前瞻性研究中，150名接受常规结肠镜检查的门诊患者被随机分配接受以下治疗：（1）低剂量咪达唑仑（35微克/千克）和哌替啶（48名患者700微克/千克，102名患者500微克/千克），（2）咪达唑仑和安慰剂哌替啶，或（3）哌替啶和安慰剂咪达唑仑。
与第2组（7分；95%置信区间[-2 - 17]）和第3组（2分；95%置信区间[-7 - 12]）相比，第1组的耐受性（视觉模拟量表，0至100分：0 = 极佳；100 = 无法忍受）改善并不显著。同样，与其他组相比，第1组的疼痛也没有显著改善。男性（p < 0.001）和操作时间较短（p = 0.004），而非遗忘，与更好的患者耐受性和更少的疼痛相关。所有组的患者满意度相似。氧饱和度降低和低血压分别发生在33%和11%的患者中，三组的发生频率相似。
在本研究中，与单独使用任何一种药物相比，低剂量咪达唑仑和哌替啶联合使用并不能提高结肠镜检查期间患者的耐受性和减轻疼痛。应用低剂量咪达唑仑时，两种药物联合使用后氧饱和度降低和低血压的发生频率不会更高。对于个体患者，镇静和镇痛应基于内镜医师的临床判断。
