丙泊酚镇静对比咪达唑仑推注或滴定用于门诊结肠镜检查：一项前瞻性随机双盲研究

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翻译：何幼芹  编辑：冯玉蓉  审校：曹莹

背景及目的：目前门诊结肠镜检查过程中最安全、最有效的镇静方法尚不清楚。本研究旨在比较丙泊酚镇静与咪达唑仑推注或滴定给药在门诊结肠镜检查患者中的有效性和安全性。

方法：将接受结肠镜检查的患者随机分为丙泊酚组、咪达唑仑推注组和咪达唑仑滴定组。丙泊酚组：静脉推注0.5 mg/kg（0.05 ml/kg）后以0.25 mg/kg（0.025 ml/kg）进行滴定。咪达唑仑推注组：接受单次快速注射哌替啶和咪达唑仑，剂量根据年龄和体重的列线图计算。咪达唑仑滴定组：按ASA指南每2 ~ 3 min增加咪达唑仑和哌替啶的剂量直到镇静深度满足检查操作。比较三组的总体检查时间、诱导时间、恢复时间和出院时间。此外，还比较了患者满意度和不良事件的发生率。

结果：本研究共纳入267例患者(各研究组89例)。丙泊酚组患者的总体检查时间(39.5 vs 59.4 vs 58.1 min; P < 0.001)、诱导时间 (4.6 vs 6.3 vs 7.6 min; P < 0.001)、恢复时间(11.5 vs 29.5 vs 29.2 min; P < 0.001)和出院时间(20.6 vs 34.9 vs 34.7 min; P < 0.001)均比咪达唑仑推注组和咪达唑仑滴定组短。此外，丙泊酚组患者的满意度高于静脉推注或滴定咪达唑仑+哌替啶组（9.9 vs 9.6 vs 9.6 vs 9.6；P=0.007，4.9 vs 4.7 vs 4.8；P=0.008）。各组间不良事件无显著差异。

结论：本项随机试验结果表明，在门诊结肠镜检查过程中的内镜室周转效率和患者满意度方面，丙泊酚镇静优于静脉推注或滴定咪达唑仑。

原始文献来源：Kim DB, Kim JS, Huh CW, et al. Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study[J]. Gastrointest. Endosc., 2020, undefined: undefined.

Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study

Abstract

BACKGROUND AND AIMS:The safest and most efficient method of sedation for outpatient colonoscopy remains unclear.The study aimed to compare the efficiency and safety of bolus administration of midazolam compared with titrated administration and propofol administration for patients undergoing outpatient colonoscopy.

METHODS:We randomly divided patients undergoing colonoscopy into the propofol group, bolus midazolam group, and titrated midazolam group. We compared total procedure time, induction time, recovery time, and discharge time between the 3 groups. We also compared patient satisfaction and the incidence of adverse events.

RESULTS: In total, 267 patients (89 in each study group) were enrolled during the study period.Patients in the propofol group had a shorter total procedure time (39.5 vs 59.4 vs 58.1 min; P < .001), induction time (4.6 vs 6.3 vs 7.6 min; P < .001), recovery time (11.5 vs 29.5 vs 29.2 min; P < .001), and discharge time (20.6 vs 34.9 vs 34.7 min; P < .001) than patients in the bolus midazolam group and titrated midazolam group. Patients in the propofol group reported higher degrees of satisfaction than patients in the bolus or titrated midazolam plus meperidine groups (9.9 vs 9.6 vs 9.6; P = 0.007, 4.9 vs 4.7 vs 4.8; P = .008). Adverse events were not significantly different between groups.

CONCLUSIONS: In this randomized trial, propofol was superior to bolus or titrated midazolam in terms of endoscopy unit efficiency and patient satisfaction during outpatient colonoscopy.

   
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