Lamireau T, Dubreuil M, Daconceicao M
Division of Pediatric Gastroenterology, Children's Hospital, Bordeaux, France.
J Pediatr Gastroenterol Nutr. 1998 Aug;27(2):172-5. doi: 10.1097/00005176-199808000-00008.
Hypoxia may occur in children undergoing upper digestive endoscopy under sedation. The purpose of this study was to compare the occurrence of desaturation during intravenous sedation with that which occurs during general anesthesia.
Thirty-six patients between 3 months and 6 years old underwent a diagnostic esophagogastroduodenoscopy under sedation (n = 18) or general anesthesia (n = 18). Oxygen pulse oximetry, heart rate, and mean arterial pressure were monitored throughout the procedure. At the end of the procedure, the operator gave the value of the endoscopy satisfaction score on a scale of I (very good conditions) to IV (impossible procedure).
The minimum oxygen pulse oximetry value was significantly lower in the sedation group compared with that in the general anesthesia group (89 +/- 5 vs. 97 +/- 1; p < 0.001). In the general anesthesia group, the oxygen pulse oximetry level declined to less than 95% in only one child; but in the sedation group, it declined to less than 95% in 16 patients (5.5% vs. 89%). Nine patients had a profound desaturation in sedation group (oxygen pulse oximetry < 90%); no patients in the general anesthesia group had desaturation (50% vs. 0%). In the general anesthesia group, heart rate and mean arterial pressure remained stable during the whole procedure, whereas in the sedation group, heart rate and mean arterial pressure increased significantly during the procedure. The endoscopy satisfaction score was I in all 18 patients in the general anesthesia group, whereas in the sedation group, it was I in only 2 patients, II in 8 patients, and III in 10 patients.
These results confirm that hypoxia during upper digestive endoscopy in patients under sedation is a frequent occurrence in children. When compared with sedation, general anesthesia is a safer technique that prevents hypoxia and allows the gastroenterologist to perform the endoscopy under better conditions.
接受镇静下上消化道内镜检查的儿童可能会发生缺氧。本研究的目的是比较静脉镇静期间与全身麻醉期间血氧饱和度降低的发生率。
36例3个月至6岁的患者在镇静（n = 18）或全身麻醉（n = 18）下接受诊断性食管胃十二指肠镜检查。在整个过程中监测氧脉搏血氧饱和度、心率和平均动脉压。在检查结束时，操作人员根据I（非常好的条件）至IV（无法进行检查）的评分标准给出内镜检查满意度评分。
镇静组的最低氧脉搏血氧饱和度值显著低于全身麻醉组（89±5 vs. 97±1；p < 0.001）。在全身麻醉组中，只有一名儿童的氧脉搏血氧饱和度水平降至低于95%；但在镇静组中，有16名患者（5.5% vs. 89%）降至低于95%。镇静组有9名患者出现严重的血氧饱和度降低（氧脉搏血氧饱和度< 90%）；全身麻醉组无患者出现血氧饱和度降低（50% vs. 0%）。在全身麻醉组中，心率和平均动脉压在整个过程中保持稳定，而在镇静组中，心率和平均动脉压在过程中显著升高。全身麻醉组的18例患者内镜检查满意度评分均为I，而在镇静组中，只有2例为I，8例为II，10例为III。
这些结果证实，镇静下患者上消化道内镜检查期间的缺氧在儿童中很常见。与镇静相比，全身麻醉是一种更安全的技术，可预防缺氧，并使胃肠病学家能够在更好的条件下进行内镜检查。
