自控鎮靜鎮痛在胃腸內鏡診療中的應用_West China Medical Journal

Authors：

宋華勇 ¹ , 張濤 ¹ , 張光信 ¹ ,  王曉 ²

1. ;
2. ;

Corresponding?author：

王曉, Email: wangxiao2005_1@hotmail.com

Keywords：

胃腸內鏡; 自控鎮靜鎮痛; 個性化用藥

DOI：

10.7507/1002-0179.201604215

Video：

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Abstract Full text Figures/Tables Video References Cited by

胃腸內鏡作為胃腸道疾患的重要診療手段，其侵襲性操作所帶來的痛苦和緊張焦慮等是妨礙許多患者接受內鏡檢查的主要原因。實施鎮靜鎮痛會增加患者的耐受性，抵抗焦慮并減少疼痛不適，但同時也增加了心肺系統并發癥的風險及檢查的費用。因此根據不同患者進行個性化鎮靜鎮痛的自控方式被引入胃腸內鏡診療的鎮靜鎮痛中，其使用專用的輸液泵，通過易于操縱的按鈕，由患者自己決定用藥時間及藥量，體現了按需給藥和個體化用藥的原則。自控鎮靜鎮痛較傳統的鎮靜鎮痛模式可為胃腸內鏡診療提供更為安全高效的鎮靜鎮痛。

Citation： 宋華勇, 張濤, 張光信, 王曉. 自控鎮靜鎮痛在胃腸內鏡診療中的應用. West China Medical Journal, 2017, 32(5): 782-785. doi: 10.7507/1002-0179.201604215 Copy

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2.	Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med, 2008, 23(6): 834-840.
3.	Arrowsmith JB, Gerstman BB, Fleischer D, et al. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc, 1991(37): 421-427.
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5.	Vargo JJ, Niklewski PJ, Williams JL, et al. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1. 38 million procedures. Gastrointest Endosc, 2017, 85(1): 101-108.
6.	Khiani VS, Soulos P, Gancayco J, et al. Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. Clin Gastroenterol Hepatol, 2012, 10(1): 58-64. e1.
7.	Inadomi JM, Gunnarsson CL, Rizzo JA, et al. Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. Gastrointest Endosc, 2010, 72(3): 580-586.
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9.	Korman LY, Haddad NG, Metz DC, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc, 2014, 79(4): 657-662.
10.	Adeyemo A, Bannazadeh M, Riggs T, et al. Does sedation type affect colonoscopy perforation rates?. Dis Colon Rectum, 2014, 57(1): 110-114.
11.	Wernli KJ, Brenner AT, Rutter CM, et al. Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016, 150(4): 888-894, quiz e18.
12.	Radaelli F, Meucci G, Minoli G, et al. Colonoscopy practice in Italy: a prospective survey on behalf of the Italian Association of Hospital Gastroenterologists. Dig Liver Dis, 2008, 40(11): 897-904.
13.	Lee DW, Chan AC, Wong SK, et al. The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study. Hong Kong Med J, 2004, 10(2): 84-88.
14.	Schutz SM, Lee JG, Schmitt CM, et al. Clues to patient dissatisfaction with conscious sedation for colonoscopy. Am J Gastroenterol, 1994, 89(9): 1476-1479.
15.	Agostoni M, Fanti L, Arcidiacono PG, et al. Midazolam and pethidineversus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultra-sound endoscopy: a prospective randomized controlled trial. Digest Liver Dis, 2007, 39: 1024-1029.
16.	Hwang J, Jeon Y, Park HP, et al. Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand, 2005, 49(9): 1334-1338.
17.	Mandel JE, Tanner JW, Lichtenstein GR, et al. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanilversus midazolam/fentanyl for colonoscopy. Anesth Analg, 2008, 106(2): 434-439, table of contents.
18.	Sümpelmann R, Büsing H, Schr?der D, et al. Patient-controlled analgesia with clonidine and piritramide. Anaesthesist, 1996, 45(1): 88-94.
19.	Nilsson A, Folke S, Susanne ?, et al. Patient-Controlled sedation and analgesia with propofol and alfentanil: a preliminary safety evaluation prior to use of Non-Anaesthesiology doctors. Open J Anesthesiol, 2012, 2: 47-52.
20.	Cook LB, Lockwood GG, Moore CM, et al. True patient-controlled sedation. Anaesthesia, 1993, 48(12): 1039-1044.
21.	Lee DW, Li AC, Ko CW, et al. Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes. Gastrointest Endosc, 2007, 65(3): 424-429.
22.	Sultan SS. Patient-controlled sedation with propofol/remifentanilversus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth, 2014, 8(Suppl 1): S36-S40.
23.	宋華勇, 李軍祥, 劉娟, 等. 瑞芬太尼與異丙酚混合溶液自控鎮靜鎮痛在纖維結腸鏡檢查中的應用. 世界華人消化雜志, 2014, 22(29): 4519.
24.	Jowell PS, Eisen G, Onken J, et al. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc, 1996, 43(5): 490-494.
25.	Külling D, Fantin AC, Biro P, et al. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc, 2001, 54(1): 1-7.
26.	Roseveare C, Seavell C, Patel P, et al. Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study. Endoscopy, 1998, 30(5): 482-483.
27.	Liu SY, Poon CM, Leung TL, et al. Nurse-administered propofol-alfentanil sedation using a patient-controlled analgesia pump compared with opioid-benzodiazepine sedation for outpatient colonoscopy. Endoscopy, 2009, 41(6): 522-528.
28.	宋華勇, 張濤, 張光信, 等. 瑞芬太尼與丙泊酚混合溶液自控鎮痛鎮靜在老年患者腸鏡檢查中的應用. 華西醫學, 2016, 31(10): 1682-1685.
29.	Russel D. Development of the technology for " Diprifusor” TCI systems. Anaesthesia, 1998, 53(Suppl 1): 22-27.
30.	Gillham MJ, Hutchinson RC, Carter R, et al. Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study. Gastrointest Endosc, 2001, 54(1): 14-17.
31.	Mazanikov M, Udd M, Kyl?np?? L, et al. A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP. Endoscopy, 2013, 45(11): 915-919.
32.	Goudra BG, Singh PM, Chandrasekhara V. SEDASYS^?, airway, oxygenation, and ventilation: anticipating and managing the challenges. Dig Dis Sci, 2014, 59(5): 920-927.
33.	Goudra BG, Singh PM. SEDASYS, sedation, and the unknown. J Clin Anesth, 2014, 26(4): 334-336.

1. ?Bynum SA, Davis JL, Green BL, et al. Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. Am J Health Promot, 2012, 26(5): 295-300.
2. Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med, 2008, 23(6): 834-840.
3. Arrowsmith JB, Gerstman BB, Fleischer D, et al. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc, 1991(37): 421-427.
4. Froehlich F, Gonvers JJ, Fried M. Conscious sedation, clinically relevant complications and monitoring of endoscopy: results of a nationwide survey in Switzerland. Endoscopy, 1994, 26(2): 231-234.
5. Vargo JJ, Niklewski PJ, Williams JL, et al. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1. 38 million procedures. Gastrointest Endosc, 2017, 85(1): 101-108.
6. Khiani VS, Soulos P, Gancayco J, et al. Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. Clin Gastroenterol Hepatol, 2012, 10(1): 58-64. e1.
7. Inadomi JM, Gunnarsson CL, Rizzo JA, et al. Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. Gastrointest Endosc, 2010, 72(3): 580-586.
8. Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med, 2013, 173(7): 551-556.
9. Korman LY, Haddad NG, Metz DC, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc, 2014, 79(4): 657-662.
10. Adeyemo A, Bannazadeh M, Riggs T, et al. Does sedation type affect colonoscopy perforation rates?. Dis Colon Rectum, 2014, 57(1): 110-114.
11. Wernli KJ, Brenner AT, Rutter CM, et al. Risks associated with anesthesia services during colonoscopy. Gastroenterology. 2016, 150(4): 888-894, quiz e18.
12. Radaelli F, Meucci G, Minoli G, et al. Colonoscopy practice in Italy: a prospective survey on behalf of the Italian Association of Hospital Gastroenterologists. Dig Liver Dis, 2008, 40(11): 897-904.
13. Lee DW, Chan AC, Wong SK, et al. The safety, feasibility, and acceptability of patient-controlled sedation for colonoscopy: prospective study. Hong Kong Med J, 2004, 10(2): 84-88.
14. Schutz SM, Lee JG, Schmitt CM, et al. Clues to patient dissatisfaction with conscious sedation for colonoscopy. Am J Gastroenterol, 1994, 89(9): 1476-1479.
15. Agostoni M, Fanti L, Arcidiacono PG, et al. Midazolam and pethidineversus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultra-sound endoscopy: a prospective randomized controlled trial. Digest Liver Dis, 2007, 39: 1024-1029.
16. Hwang J, Jeon Y, Park HP, et al. Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand, 2005, 49(9): 1334-1338.
17. Mandel JE, Tanner JW, Lichtenstein GR, et al. A randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanilversus midazolam/fentanyl for colonoscopy. Anesth Analg, 2008, 106(2): 434-439, table of contents.
18. Sümpelmann R, Büsing H, Schr?der D, et al. Patient-controlled analgesia with clonidine and piritramide. Anaesthesist, 1996, 45(1): 88-94.
19. Nilsson A, Folke S, Susanne ?, et al. Patient-Controlled sedation and analgesia with propofol and alfentanil: a preliminary safety evaluation prior to use of Non-Anaesthesiology doctors. Open J Anesthesiol, 2012, 2: 47-52.
20. Cook LB, Lockwood GG, Moore CM, et al. True patient-controlled sedation. Anaesthesia, 1993, 48(12): 1039-1044.
21. Lee DW, Li AC, Ko CW, et al. Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes. Gastrointest Endosc, 2007, 65(3): 424-429.
22. Sultan SS. Patient-controlled sedation with propofol/remifentanilversus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study. Saudi J Anaesth, 2014, 8(Suppl 1): S36-S40.
23. 宋華勇, 李軍祥, 劉娟, 等. 瑞芬太尼與異丙酚混合溶液自控鎮靜鎮痛在纖維結腸鏡檢查中的應用. 世界華人消化雜志, 2014, 22(29): 4519.
24. Jowell PS, Eisen G, Onken J, et al. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc, 1996, 43(5): 490-494.
25. Külling D, Fantin AC, Biro P, et al. Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil. Gastrointest Endosc, 2001, 54(1): 1-7.
26. Roseveare C, Seavell C, Patel P, et al. Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study. Endoscopy, 1998, 30(5): 482-483.
27. Liu SY, Poon CM, Leung TL, et al. Nurse-administered propofol-alfentanil sedation using a patient-controlled analgesia pump compared with opioid-benzodiazepine sedation for outpatient colonoscopy. Endoscopy, 2009, 41(6): 522-528.
28. 宋華勇, 張濤, 張光信, 等. 瑞芬太尼與丙泊酚混合溶液自控鎮痛鎮靜在老年患者腸鏡檢查中的應用. 華西醫學, 2016, 31(10): 1682-1685.
29. Russel D. Development of the technology for " Diprifusor” TCI systems. Anaesthesia, 1998, 53(Suppl 1): 22-27.
30. Gillham MJ, Hutchinson RC, Carter R, et al. Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study. Gastrointest Endosc, 2001, 54(1): 14-17.
31. Mazanikov M, Udd M, Kyl?np?? L, et al. A randomized comparison of target-controlled propofol infusion and patient-controlled sedation during ERCP. Endoscopy, 2013, 45(11): 915-919.
32. Goudra BG, Singh PM, Chandrasekhara V. SEDASYS^?, airway, oxygenation, and ventilation: anticipating and managing the challenges. Dig Dis Sci, 2014, 59(5): 920-927.
33. Goudra BG, Singh PM. SEDASYS, sedation, and the unknown. J Clin Anesth, 2014, 26(4): 334-336.

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自控鎮靜鎮痛在胃腸內鏡診療中的應用

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