- 期刊
Necessity of Sedation and Monitoring for Colonoscopy
大腸鏡檢查使用鎮定劑及監測的必要性
摘要
大腸鏡檢查時是否需要給予鎮定劑及持續監測是見仁見智的，除了評估可能的好處之外，仍應考慮可能出現的壞處。本文為單一內視鏡醫師在做大腸鏡時的常規，及選擇性使用鎮定劑及監測經驗的回溯性評估。 民國86年9月8日起，排除未完成全大腸檢查者，共有1310位患者接受了全大腸鏡檢查。其中男性666位，女性644位，平均年齡為49.7歲，並有317位患者同時接受息肉切除。統計採用Chi-square test, P值小於0.05 認為有意義。 482位患者未接受任何藥物，其中有35位患者（7.9%）心跳低於每分鐘50次。610位患者在檢查前接受了25毫克的meperidine及2.5毫克的midazolam的靜脈注射，40位患者（6.5%）在檢查中心跳少於50/分。138位患者在檢查前接受了50毫克的meperidine及5毫克的midazolam靜脈注射，四位患者（2.9%）在檢查中心跳少於50/分。80位患者在檢查前接受了25毫克的meperidine 靜脈注射，11位患者（13.8%）在檢查中心跳少於50/分。心跳過慢的患者在只接受25毫克的meperidine組比其他各組有意義的較高（和未接受任何藥物組比，P=0.05；和接受 25毫克的meperidine及2.5毫克的midazolam靜脈注射組比，P=0.0208；和接受了50毫克的meperidine及5毫克的midazolam靜脈注射組比，P=0.0023)。在653件大腸鏡檢查只以心電圖監測，657件大腸鏡檢查以心電圖及血壓計來監測，其中六位患者（0.9%）的心縮壓低於90毫米汞柱。整個系列中，沒有患者因做大腸鏡檢查而死亡，有二例腸穿孔的病例，但和使用鎮定劑及是否持續監測無關。 本系列的經驗顯示，檢查前給予藥物可使大腸鏡容易施行，合併症也不高；大多數患者都能忍受選擇性的給予鎮定劑；持續及同時的測量血壓、心跳、及氧飽和度應考慮是否合於經濟效益。
關鍵字
無資料並列摘要
Purpose: Routine use of sedation and monitoring during colonoscopy has been controversial. Advantages should be judged against their disadvantages. This is a retrospective study of a single endoscopist's experience comparing routine and selective use of sedation and monitoring. Materials and Methods: From September 1997 to August 2001, 1310 patients received total colonoscopy with 317 patients receiving polypectomies simultaneously. There were 666 males and 644 females. The average age was 49.7 years old. Patients who had less than a total colonoscopy were excluded. Chi-square test was used to analyze the difference between groups. P ＜ 0.05 was considered statistically significant. Results: Four hundred and eighty-two patients did not receive any medications. Of these, 35 patients (7.3%) had heart rate below 50/min during the procedure. Six hundred and ten patients received 25 mg of meperidine and 2.5 mg of midazolam intravenously prior to examination. Of these, 40 patients (6.5%) had heart rate below 50/min during the procedure. One hundred and thirty-eight patients received 50 mg of meperidine and 5 mg of midazolam intravenously prior to examination. Of these, four patients (2.9%) had heart rate below 50/min during the procedure. Eighty patients received 25 mg of meperidine intravenously prior to examination, 11 patients (13.8%) had heart rate below 50/min during the procedure. Patients receiving only 25 mg of meperidine had significantly higher rate of developing bradycardia (Compared with no medications, P=0.05; compared with 25mg meperidine and 2.5 mg midazolam, P=0.0208; compared with 50 mg meperidine and 5 mg midazolam, P=0.0023). Six hundred and fifty-three colonoscopies were performed under EKG monitoring. Six hundred and fifty-seven colonoscopies were performed under EKG and blood pressure monitoring, six patients (0.9%) had significant hypotension with systolic pressure below 90 mmHg. There was no mortality encountered, but there were two perforations unrelated to the medications or lack of monitoring. Conclusions: This series suggests that premedication may facilitate colonoscopic examination with minimal complications; sedation by choice is well tolerated in selected patients; continuous and simultaneous monitoring of blood pressure, heart rate, and oxygen saturation should be justified by its cost and benefits.