设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

采用异丙酚平衡镇静和芬太尼与仅咪唑安定为选择性上消化道内镜检查行适度镇静:一项随机临床试验

发布日期:2014-1-29 12:40:33 文章来源:Endoscopy 作者次数:1197
    采用异丙酚平衡镇静和芬太尼与仅咪唑安定为选择性上消化道内镜检查行适度镇静:一项随机临床试验

    B. E. Levitzky1, R. Lopez2, J. A. Dumot1, J. J. Vargo1

    1美国俄亥俄州克利夫兰凯撒西储大克利夫兰诊所勒纳医学院胃肠病和肝病科

    2美国俄亥俄州克利夫兰凯撒西储大学克利夫兰诊所勒纳医学院生物统计系

    背景和研究目的:异丙酚平衡镇静(BPS)结合异丙酚和鸦片剂与苯二氮卓类,以此达到适度镇静。关于在选择性食管胃十二指肠镜检查EGD)期间异丙酚平衡镇静结果与采用鸦片剂与苯二氮卓类的标准镇静结果相比较的研究资料较少。本研究的主要终点目的是比较康复区病人对采用BPS与标准镇静的EGD的满意程度。

    患者和方法:本研究为前瞻性单盲随机试验,110例门诊病人接受了选择性 EGD,并按11的比例被随机分为BPS或标准镇静组。当患者完全恢复后,采用一个100mm的视觉模拟评分(VAS)对患者满意度的主要结果进行评估(1为完全不满意,100为完全满意)。同时也采用VAS对镇静恢复时间和疼痛回忆与作呕(1为无,100为严重)进行了评估。

    结果:对美国麻醉医师协会(ASA)、Mallampati分类、年龄、性别与身体质量指数(BMI)来说,BPS组与标准镇静组是相似的。与标准镇静组相比,BPS组显示手术满意度中位数较高(9985P < 0.001),疼痛回忆与作呕中位得分较低(二者均为P < 0.001)。BPS可使中位恢复时间(分)缩短(1123P < 0.001)。对于多元回归分析来说,病人满意度的预测因素包括异丙酚的使用,年龄的增长和芬太尼剂量的增加。

    结论:BPS是为达到适度镇静由训练有素的内镜医师实施的,它可以使病人在EGD期间获得比标准镇静更高的满意度和更短的恢复时间。

    ------------------------------------------------------------------------------------------

     

    Moderate sedation for elective upper endoscopy with balanced propofol versus fentanyl and midazolam alone: a randomized clinical trial

    B. E. Levitzky1, R. Lopez2, J. A. Dumot1, J. J. Vargo1

    1Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA

    2Department of Biostatistics, ClevelandClinicLernerCollegeof Medicine ofCaseWesternUniversity,Cleveland,Ohio,USA

    Background and study aims: Balanced propofol sedation (BPS) combines propofol with opiates and benzodiazepines and targets at moderate sedation. Data comparing outcomes of BPS and standard sedation with opiates and benzodiazepines during elective esophagogastroduodenoscopy (EGD) are sparse. The primary end point of this study was to compare, in the recovery area, patient satisfaction with EGD following BPS versus standard sedation.

    Patients and methods: Prospective, single-blinded randomized trial in 110 outpatients undergoing elective EGD and randomized 1:1 to BPS or standard sedation. Upon full recovery, the primary outcome of patient satisfaction was assessed using a 100-mm visual analogue scale (VAS) (1 = not at all satisfied, 100 = completely satisfied). Sedation recovery times and recall of pain and gagging (1 = none, 100 = severe) were also evaluated using a VAS.

    Results: The BPS and standard sedation groups were similar regarding American Society of Anesthesiologists (ASA), Mallampati class, age, sex, and body mass index (BMI). Compared with the standard sedation arm, the BPS group exhibited higher median procedural satisfaction (99 vs. 85, P < 0.001), and lower median scores for recall of pain (P < 0.001) and gagging (P < 0.001). BPS resulted in a shorter median recovery time (min) (11 vs. 23, P < 0.001). On multivariable regression analysis, predictors of patient satisfaction included use of propofol, increased age, and higher fentanyl dosage.

    Conclusions: BPS targeted to moderate sedation by adequately trained endoscopists results in superior patient satisfaction and shorter recovery times than standard sedation alone during EGD.

     

    (作者:)
相关评论
用户名: 登录