| 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. |
