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消化道内镜操作的程序镇静概述

Author
Jonathan Cohen, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
徐红, 主任医师，教授

引言

消化道内镜的出现极大地拓展了胃肠病学专家的诊断和治疗能力。患者能充分耐受对于成功完成安全的内镜检查及之后的随访依从至关重要。因此，为利于操作并提高患者舒适度，内镜医师已发展出了一系列给予各种镇静剂和止痛剂的技术。

本专题将着重总结消化道内镜操作时的标准程序镇静方法。镇静相关的并发症、无镇静的内镜操作相关问题以及镇静困难患者的管理将在别处讨论。 (参见“胃肠内镜程序镇静的并发症”和“无镇静胃肠内镜检查”和“胃肠内镜中等程度程序镇静的替代和辅助方案”)

操作前的准备和评估

在进行消化道内镜操作的术前镇静前，应收集所有患者的病史并行体格检查，从而识别出可能会增加不良结局风险的因素。 (参见“胃肠内镜程序镇静的并发症”)

获取病史时应确定患者有无以下任何情况：

●严重的心脏或肺部疾病

                 

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Literature review current through: 2017-07 . | This topic last updated: 2016-03-28.
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References
Top
  1. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96:1004.
  2. Godwin SA, Caro DA, Wolf SJ, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med 2005; 45:177.
  3. Cohen LB, Delegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology 2007; 133:675.
  4. Poirier MP, Gonzalez Del-Rey JA, McAneney CM, DiGiulio GA. Utility of monitoring capnography, pulse oximetry, and vital signs in the detection of airway mishaps: a hyperoxemic animal model. Am J Emerg Med 1998; 16:350.
  5. Vargo JJ, Zuccaro G Jr, Dumot JA, et al. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. Gastrointest Endosc 2002; 55:826.
  6. Lightdale JR, Goldmann DA, Feldman HA, et al. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial. Pediatrics 2006; 117:e1170.
  7. Beitz A, Riphaus A, Meining A, et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol 2012; 107:1205.
  8. Nelson DB, Freeman ML, Silvis SE, et al. A randomized, controlled trial of transcutaneous carbon dioxide monitoring during ERCP. Gastrointest Endosc 2000; 51:288.
  9. Gross JB, Long WB. Nasal oxygen alleviates hypoxemia in colonoscopy patients sedated with midazolam and meperidine. Gastrointest Endosc 1990; 36:26.
  10. Wang CY, Ling LC, Cardosa MS, et al. Hypoxia during upper gastrointestinal endoscopy with and without sedation and the effect of pre-oxygenation on oxygen saturation. Anaesthesia 2000; 55:654.
  11. Waring JP, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003; 58:317.
  12. Reshef R, Shiller M, Kinberg R, et al. A prospective study evaluating the usefulness of continuous supplemental oxygen in various endoscopic procedures. Isr J Med Sci 1996; 32:736.
  13. Jurell KR, O'Connor KW, Slack J, et al. Effect of supplemental oxygen on cardiopulmonary changes during gastrointestinal endoscopy. Gastrointest Endosc 1994; 40:665.
  14. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc 2008; 67:910.
  15. Forbes GM, Collins BJ. Nitrous oxide for colonoscopy: a randomized controlled study. Gastrointest Endosc 2000; 51:271.
  16. Stermer E, Gaitini L, Yudashkin M, et al. Patient-controlled analgesia for conscious sedation during colonoscopy: a randomized controlled study. Gastrointest Endosc 2000; 51:278.
  17. Aboumarzouk OM, Agarwal T, Syed Nong Chek SA, et al. Nitrous oxide for colonoscopy. Cochrane Database Syst Rev 2011; :CD008506.
  18. Etzkorn KP, Diab F, Brown RD, et al. Endoscopic retrograde cholangiopancreatography under general anesthesia: indications and results. Gastrointest Endosc 1998; 47:363.
  19. Wilcox CM, Forsmark CE, Cello JP. Utility of droperidol for conscious sedation in gastrointestinal endoscopic procedures. Gastrointest Endosc 1990; 36:112.
  20. Cohen J, Haber GB, Dorais JA, et al. A randomized, double-blind study of the use of droperidol for conscious sedation during therapeutic endoscopy in difficult to sedate patients. Gastrointest Endosc 2000; 51:546.
  21. Yimcharoen P, Fogel EL, Kovacs RJ, et al. Droperidol, when used for sedation during ERCP, may prolong the QT interval. Gastrointest Endosc 2006; 63:979.
  22. Vasudevan AE, Goh KL, Bulgiba AM. Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy. Am J Gastroenterol 2002; 97:1717.
  23. Assy N, Rosser BG, Grahame GR, Minuk GY. Risk of sedation for upper GI endoscopy exacerbating subclinical hepatic encephalopathy in patients with cirrhosis. Gastrointest Endosc 1999; 49:690.
  24. Evans LT, Saberi S, Kim HM, et al. Pharyngeal anesthesia during sedated EGDs: is "the spray" beneficial? A meta-analysis and systematic review. Gastrointest Endosc 2006; 63:761.
  25. Zakko SF, Seifert HA, Gross JB. A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study. Gastrointest Endosc 1999; 49:684.
  26. Scholer SG, Schafer DF, Potter JF. The effect of age on the relative potency of midazolam and diazepam for sedation in upper gastrointestinal endoscopy. J Clin Gastroenterol 1990; 12:145.
  27. Bell GD, Spickett GP, Reeve PA, et al. Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient. Br J Clin Pharmacol 1987; 23:241.
  28. Robertson DJ, Jacobs DP, Mackenzie TA, et al. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gastrointestinal endoscopy. Aliment Pharmacol Ther 2009; 29:817.
  29. ASGE Standard of Practice Committee, Shergill AK, Ben-Menachem T, et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2012; 76:18.
  30. Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49:924.
  31. Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995; 7:500.