老年患者自控镇静与全静脉镇静进行肠镜检查比较

Patient-controlled Sedation versus Intravenous Sedation for Colonoscopy in Elderly Patients: a Prospective Randomized Controlled Trial

目的:比较老年患者自控镇静和全静脉镇静施行结肠镜检查的安全性、有效性和患者可接受性。方法:100例行结肠镜检查65岁以上患者随机分两组:(1)患者自控镇静组异丙酚和阿芬太尼的混合制剂通过自控镇静的方式给予,每次给药为异丙酚4.8mg和阿芬太尼12μg,无负荷剂量,锁定时间为0min。(2)全静脉组按照0.5mg/kg和0.1mg/kg的剂量给予哌替啶和安定的混合液,如需要可以根据麻醉医师的观察适当追加。观察指标包括心肺并发症、疼痛评分、满意程度评分和恢复时间等。结果:自控镇静组应用的异丙酚平均剂量为0.89±0.56mg/kg,阿芬太尼的剂量2.90±1.4μg/kg;全静脉镇静组患者的安定和哌替啶剂量分别为5.6±1.4mg和30.0±7.8mg;低血压的发生率在患者自控镇静组为6%(3例),而在全静脉麻醉组为30%(15例)(P<0.01);低氧饱和度在全静脉发生率为8%(4例),患者自控镇静组为0%(0例);患者自控镇静组和全静脉麻醉组患者的平均恢复时间分别为1min和5min,前者明显较后者短(P<0.01)。关于镇痛评分和满意度评分两组之间无显著差异。结论:在同样有效性和可接受程度情况下,老年患者进行结肠镜检查自控镇静较全静脉镇静更加安全。

Objective： A prospective randomized trial was conducted to compare the safety,effectiveness,and patient acceptance of patientcontrolled sedation and intravenous sedation for colonoscopy in a group of elderly patients undergoing outpatient colonoscopy. Methods：One hundred patients over 65 years of age were recruited and randomized to patient-controlled sedation（n = 50）or intravenous sedation （n = 50） groups by means of a computer-generated numbers. In the patient-controlled sedation group,a mixture of propofol and alfentanil was delivered by means of a patient-controlled pump;each bolus delivered 4. 8 mg propofol and 12ug alfentanil. No loading dose was used and lockout time was set at zero. In the intravenous sedation group,fixed doses of diazemuls（0.1mg/kg） and meperidine（0. 5mg/kg）were given with further increases in dosages administered at the discretion of the endoscopist. Outcome measures assessed included cardiopulmonary complications, recovery time, pain score,and satisfaction score. Results： The mean（SD） age of patients in the patient-controlled sedation and intravenous sedation sedation groups were, respectively,72. 4years（5.3）and 73.5 years（6. 1 ）. The mean dose of propofol consumed in the patientcontrolled sedation group was 0. 89（0. 56） mg/kg. The mean dose of diazemuls and meperidine consumed in intravenous sedation group were,respectively,5.6（1.4） and 30. 0（7. 8） mg. Hypotention occurred in 3（6%）patients in the patient-controlled sedation sedation group and 15（30% ）in the intravenous sedation group（P〈0. 01 ） Oxygen desaturation was recorded for 4 patients（8 % ）in the intravenous sedation group. The median（interquartile range （IQR）recovery time was significantly shorter in the patient-controlled sedation group compared with the intravenous sedation group（respectively, 1 minutes （IQR1-5） vs. 5 minutes （IQR5-10）;P〈0. 01）. There were no statistically significant differences between groups for pain and satisfation scores. Conclusion：Patient-controlled sedation appears t be safer than intravenous sedation,with comparable effectiveness and acceptance,in elderly patients undergoing elective outpatient colonscopy.