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1、Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures,常规胃镜肠镜过程中专业麻醉师镇静下患者的安全性： 一项对138万次手术的分析,GASTROINTESTINAL ENDOSCOPY Volume 85, No. 1 : 2017IF：6.215,Background and Aims: Sedation for GI endoscopy directed
2、by anesthesia professionals (ADS) is used with the intention of improving throughput and patient satisfaction. However, data on its safety are sparse because of the lack of adequately powered, randomized controlled trials comparing it with endoscopist-directed sedation (EDS). This study was intended
3、 to determine whether ADS provides a safety advantage when compared with EDS for EGD and colonoscopy. 背景和目的：在胃肠镜过程中让专业麻醉师进行麻醉（ADS）以提高工作量并让患者满意。然而，关于其安全性的证据却极少，因为没有对比内镜医生进行麻醉（EDS）的随机对照实验。本研究旨在研究胃镜、肠镜中ADS比EDS是否具有安全性上的优势。,Abstract 摘要,Methods: This retrospective, nonrandomized, observational cohort stud
4、y used the Clinical Outcomes Research Initiative National Endoscopic Database, a network of 84 sites in the United States composed of academic, community, health maintenance organization, military, and Veterans Affairs practices. Serious adverse events (SAEs) were defined as any event requiring admi
5、nistration of cardiopulmonary resuscitation, hospital or emergency department admission, administration of rescue/reversal medication, emergency surgery, procedure termination because of an adverse event, intraprocedural adverse events requiring intervention, or blood transfusion. 方法：本研究是回顾性、非随机、观察性
6、队列研究，数据来源于临床结果研究计划国家内镜数据库（该网络由美国84个网点构成，包括大学、社区、保健机构、军队及退伍军人事务部）。严重并发症（SAEs）包括任何需要心肺复苏、住院或急救入院、应用急救药物、急诊手术的情况，以及需要停止内镜的不良事件、术中不良事件需要干预或输血者。,Results: There were 1,388,235 patients in this study that included 880,182 colonoscopy procedures (21% ADS) and 508,053 EGD procedures (23% ADS) between 2002 an
7、d 2013. When compared with EDS, the propensity adjusted SAE risk for patients receiving ADS was similar for colonoscopy (OR, .93; 95% CI, .82-1.06) but higher for EGD (OR, 1.33; 95% CI, 1.18-1.50). Additionally, with further stratification by American Society of Anesthesiologists (ASA) class, the us
8、e of ADS was associated with a higher SAE risk for ASA I/II and ASA III subjects undergoing EGD and showed no difference for either group undergoing colonoscopy. The sample size was not sufficient to make a conclusion regarding ASA IV/V patients. 结果：2002年至2013年间，共138万患者纳入研究，包括88万肠镜(21% ADS)和50万胃镜(23
9、% ADS) 。于EDS相比，ADS的SAE风险在肠镜中与EDS相似而在胃镜中较高。另外，进一步按照美国麻醉师协会（ASA）的分级进行分层，应用ADS会使ASA I/II和ASA III患者在胃镜治疗时SAE风险更高，而在行肠镜时风险相同。这些样本量不足以用于对ASA IV/V 型患者下结论。,Conclusions: Within the confines of the SAE definitions used, use of anesthesia professionals does not appear tobring a safety benefit to patients recei
10、ving colonoscopy and is associated with an increased SAE risk for ASA I, II,and III patients undergoing EGD. 结论：在SAE的定义之内，ADS在肠镜治疗中并未带来安全性上的优势，而在胃镜治疗中ASA I, II,和III 型患者的SAE风险会增加。,Introduction 介绍,Sedation is an integral part of most GI endoscopic procedures performed in the United States. The goals o
11、f sedation are to improve the patient experience by reducing pain and anxiety, ultimately leading to bettercompliance with recommended screenings and follow up. Sedation options are primarily either endoscopists targeting minimal to moderate sedation (endoscopist directed sedation EDS) or anesthesia
12、 professionals typically targeting deep sedation or general anesthesia (anesthesia-directed sedation ADS). 在美国，胃肠镜术中麻醉是不可或缺的一部分。麻醉的目的是通过减少疼痛和焦虑来提高患者的体验，最终提高患者对筛查和随访的依从性。麻醉的方法主要有两种选择，一种是胃镜医生实施的麻醉EDS（通常以轻到中度的麻醉为目的），另一种是专业麻醉师的麻醉ADS，主要以深度麻醉和全身麻醉为目的。,With regard to colonoscopy, several studies have addre
13、ssed the method of sedation used and the effect on adenoma detection rates, a measure of quality of the procedure. One study showed no difference in the detection of polyps using moderate or deep sedation. Similarly, other studies comparing propofol delivered byan anesthesiologist and endoscopist-di
14、rected midazolam/fentanyl-based sedation found no differences in the number of patients who had adenomatous polyps detected. 关于肠镜，一些研究研究了麻醉方法对于腺瘤检出率和手术质量的影响。其中一个研究显示没有发现息肉检出率在深麻醉和浅麻醉中有何不同。相似的，另外一个研究显示专业人员使用丙泊酚麻醉和内镜医生行咪达唑仑/芬太尼对于腺瘤性息肉检出率没有影响。,Without a clear benefit in the quality of the colonoscopic
15、examination, the increased cost for the use of ADS could potentially be justified by improved safety. An appropriately powered randomized, prospective, controlled trial wouldbe impractical because of the rarity of significant events, but a few investigators have conducted retrospective studies. An i
16、ncreased rate of perforations during colonoscopies under propofol sedation and an increased risk of aspiration pneumonia with sedation delivered by anesthesia professionals have been observed. With this landscape in mind, we examined the National Endoscopic Database (NED) created by the Clinical Out
17、comes Research Initiative (CORI) spanning the years 2002 to 2013 to understand what role ADS may have in improving patient safety. 鉴于在肠镜中没有发现麻醉方式对于息肉检出率的影响，那么ADS高收取的部分费用则必须是因其安全性高于EDS。一个有效的前瞻性随机对照研究因为有缺乏主动愿意选择EDS的病例而不能实行，但是一些研究者进行了回顾性的研究，观察到肠镜中穿孔的风险在使用丙泊酚麻醉时有所升高，而吸入性肺炎的风险在ADS时升高。基于这一印象，我们查询了由CORI开发的NED数据库，抽取其中2002至2013年的病例，来研究ADS对于挺高患者安全性的作用。,
