Oei-Lim V L, Kalkman C J, Bartelsman J F, Res J C, van Wezel H B
Department of Anaesthesia, Academic Medical Centre, University of Amsterdam, The Netherlands.
Eur J Anaesthesiol. 1998 Sep;15(5):535-43. doi: 10.1046/j.1365-2346.1998.00349.x.
Hypoventilation as a consequence of deep intravenous sedation is the most frequently reported cause of cardiac arrest during upper gastrointestinal endoscopy (UGIE). Haemodynamic stress can contribute to myocardial ischaemia; therefore, this study was designed to observe prospectively the cardiorespiratory changes during UGIE using either midazolam or propofol for conscious sedation. Thirty-four patients, aged 50 years and older, ASA physical status I-III, scheduled for elective UGIE with sedation, were studied. Oxygen saturation, heart rate, non-invasive blood pressure and Holter ECG were recorded continuously starting 15 min before sedation until 15 min after the endoscopy. In addition, plasma catecholamine concentrations were determined. The results of this study are consistent with previous reports that cardiopulmonary events may occur during endoscopy, with or without sedation. Both midazolam and propofol sedation may provide some protection against haemodynamic stress in response to insertion and manipulation of the endoscope, but sedation can also contribute to the occurrence of hypoxaemia.
深度静脉镇静导致的通气不足是上消化道内镜检查（UGIE）期间心脏骤停最常见的原因。血流动力学应激可导致心肌缺血；因此，本研究旨在前瞻性观察使用咪达唑仑或丙泊酚进行清醒镇静的UGIE期间的心肺变化。研究了34例年龄50岁及以上、ASA身体状况I-III级、计划进行择期UGIE并接受镇静的患者。从镇静前15分钟开始直至内镜检查结束后15分钟，持续记录血氧饱和度、心率、无创血压和动态心电图。此外，还测定了血浆儿茶酚胺浓度。本研究结果与之前的报告一致，即在内镜检查期间，无论有无镇静，都可能发生心肺事件。咪达唑仑和丙泊酚镇静均可对内窥镜插入和操作引起的血流动力学应激提供一定保护，但镇静也可能导致低氧血症的发生。
