在内镜逆行性胆血管细胞造影术后,使用深度镇静剂与普罗波福尔进行技术成功和不良事件率
Janine B Kastelijn1, A Merel van den Berg1, Raju Talwar1
1Department of Gastroenterology and Hepatology (Janine B. Kastelijn, A. Merel van den Berg, Raju Talwar, Marije S. Koks, Karel J. van Erpecum, Paul Didden, Leon M.G. Moons, Frank P. Vleggaar).
Annals of gastroenterology
|November 21, 2024
概括
与有意识的镇静相比,用普罗波进行的深度镇静改善了内逆向胆血管细胞造影 (ERCP) 的技术成功. 然而,使用普罗波福的不良事件几乎翻了一番,包括ERCP后的胰腺炎和胆脉炎.
科学领域:
- 胃肠病学 胃肠病学
- 麻醉学 麻醉学
- 医疗程序 医疗程序
背景情况:
- 内镜逆行胆血管细胞造影 (ERCP) 的复杂性和持续时间有所增加.
- 对于ERCP的镇静实践已经从意识镇静 (二) 转向深度镇静 (propofol).
研究的目的:
- 为了比较深度镇静和意识镇静下ERCP的技术成功率和不良事件率.
- 评估基于普罗波福的深度镇静与基于米达佐拉姆的有意识镇静对ERCP结果的影响.
主要方法:
- 在2010年至2016年期间,对725名接受ERCP的患者进行了回顾性分析.
- 对接受米达佐拉姆 (有意识镇静,2010-2013年) 和普罗波 (深度镇静,2013-2016年) 患者的结局进行比较.
- 评估的结果包括30天内的技术成功和不良事件,使用单变量和多变量模型进行分析.
主要成果:
- 使用普罗波福的深度镇静与显著更高的技术成功率有关 (82%对75%,P=0.034).
- 使用普罗波的不良事件发生频率显著增加 (20%对11%,P=0.002).
- 在普罗波福尔组中观察到,ERCP后胆道炎 (5% vs. 2%) 和胰腺炎 (7% vs. 3%) 的发病率更高. 技术成功和不良事件的调整后赔率比分分别为1.53和1.95.
结论:
- 与基于米达佐拉姆的意识镇静相比,基于普罗波的深度镇静显著提高了ERCP的技术成功.
- 使用普罗波福的深度镇静几乎会使不良事件的风险增加一倍,包括ERCP后的胰腺炎和胆脉炎.
- 镇静的选择影响ERCP程序的疗效和安全性.
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