Yano H, Iishi H, Tatsuta M, Sakai N, Narahara H, Omori M
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2138-41.
BACKGROUND/AIMS: Conscious sedation increases the tolerance of patients to endoscopic examination, but arterial oxygen desaturation during endoscopy has often been reported. Elderly patients are considered to be at special risk. However, sedation-induced changes in cardiovascular function in the elderly have not been well investigated. Therefore, this study examined the effects of sedation on pulse rate, systolic blood pressure, and arterial oxygen saturation in elderly patients.
Twenty patients aged less than 60 years and 20 patients aged 60 years or more, scheduled to undergo colonoscopic removal of colorectal polyps, received 0.05 or 0.025 mg/kg body weight, respectively, of midazolam intravenously. Before, during, and after endoscopy, pulse rate, systolic blood pressure, and arterial oxygen saturation were recorded every 5 min with a pulse oximeter.
Administration of midazolam had no significant effect on pulse and arterial systolic blood pressure in either group. In contrast, midazolam significantly reduced the levels of arterial oxygen saturation during and after endoscopy in both age groups. However, although patients aged 60 years or more received midazolam at half dosage, arterial oxygen saturation during endoscopy was significantly lower and the incidence of 5% or more oxygen desaturation was significantly higher than in the patients aged less than 60 years.
Midazolam increases the tolerance of elderly patients to endoscopy, but it significantly lowers the level of arterial oxygen saturation and increases the incidence of desaturation. Continuous monitoring is especially valuable during endoscopy in the elderly.
背景/目的：清醒镇静可提高患者对内镜检查的耐受性，但内镜检查期间动脉血氧饱和度下降的情况屡有报道。老年患者被认为处于特殊风险中。然而，镇静对老年人心血管功能的影响尚未得到充分研究。因此，本研究探讨了镇静对老年患者脉搏率、收缩压和动脉血氧饱和度的影响。
计划接受结肠镜下切除大肠息肉的20名年龄小于60岁的患者和20名年龄60岁及以上的患者，分别静脉注射0.05或0.025mg/kg体重的咪达唑仑。在内镜检查前、检查期间和检查后，每隔5分钟用脉搏血氧仪记录脉搏率、收缩压和动脉血氧饱和度。
咪达唑仑给药对两组患者的脉搏和动脉收缩压均无显著影响。相比之下，咪达唑仑在两个年龄组的内镜检查期间和检查后均显著降低了动脉血氧饱和度水平。然而，尽管60岁及以上的患者接受的咪达唑仑剂量减半，但内镜检查期间的动脉血氧饱和度明显更低，血氧饱和度下降5%或更多的发生率明显高于年龄小于60岁的患者。
咪达唑仑可提高老年患者对内镜检查的耐受性，但会显著降低动脉血氧饱和度水平并增加血氧饱和度下降的发生率。在内镜检查期间对老年患者进行持续监测尤为重要。
