Shah Syed G, Brooker Jim C, Thapar Catherine, Suzuki Noriko, Williams Christopher B, Saunders Brian P
Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, Middlesex, London, United Kingdom.
Gastrointest Endosc. 2002 Jun;55(7):832-7. doi: 10.1067/mge.2002.124097.
Pain during colonoscopy is primarily related to mesenteric stretching from looping of the colonoscope insertion tube. Prompt recognition and removal of loops reduces patient discomfort and may lessen sedation requirements. Magnetic endoscope imaging allows real-time visualization of the colonoscope during insertion. The effect of magnetic endoscope imaging on patient pain and sedation requirements was assessed in a prospective randomized controlled trial.
A total of 122 consecutive patients undergoing routine colonoscopy by a single experienced endoscopist were randomized to have the procedure performed either with the endoscopist viewing the imager display (n = 62), or without the imager view (n = 60). Procedures began with administration of hyoscine-N-butylbromide alone, and sedative medications (midazolam and meperidine) were self-administered by the patient with a patient-controlled analgesia pump. Cardiorespiratory parameters were recorded and patient pain was assessed with a 100-mm visual analogue scale.
The number of attempts at straightening the colonoscope was fewer (median 8 [0-66] vs. 15 [0-87], p = 0.0076) and the duration of looping less (median 4.5 min [0-27.3 min] vs. 6.4 min [0-29.4 min]), when the endoscopist was able to see the imager view. The total number of patient demands (by patient-controlled analgesia) for medication (median 1 vs. 2.5) and total doses of midazolam (median 0.44 mg vs. 0.88 mg) and meperidine (median 16.75 mg vs. 32.5 mg) administered did not significantly differ between patients examined with or without the imager. Patient pain scores were also similar.
Magnetic endoscope imaging allows accurate assessment and straightening of loops during colonoscopy, but without a significant reduction in patient requirements for sedative medication or improvement in patient tolerance. However, the dosages of sedation drugs used were small.
结肠镜检查期间的疼痛主要与结肠镜插入管的袢曲导致的肠系膜牵拉有关。及时识别并解除袢曲可减轻患者不适，并可能减少镇静药物的需求。磁性内镜成像可在插入过程中实时显示结肠镜的情况。在一项前瞻性随机对照试验中评估了磁性内镜成像对患者疼痛及镇静药物需求的影响。
共有122例连续接受同一位经验丰富内镜医师进行常规结肠镜检查的患者被随机分为两组，一组在检查过程中内镜医师观看成像显示器（n = 62），另一组不观看成像显示器（n = 60）。检查开始时仅给予丁溴东莨菪碱，镇静药物（咪达唑仑和哌替啶）由患者通过患者自控镇痛泵自行给药。记录心肺参数，并用100毫米视觉模拟量表评估患者疼痛程度。
当内镜医师能够看到成像显示器时，拉直结肠镜的尝试次数较少（中位数8次[0 - 66次]对15次[0 - 87次]，p = 0.0076），袢曲持续时间较短（中位数4.5分钟[0 - 27.3分钟]对6.4分钟[0 - 29.4分钟]）。接受成像检查和未接受成像检查的患者之间，通过患者自控镇痛的药物总需求量（中位数1次对2.5次）以及给予的咪达唑仑总剂量（中位数0.44毫克对0.88毫克）和哌替啶总剂量（中位数16.75毫克对32.5毫克）并无显著差异。患者的疼痛评分也相似。
磁性内镜成像可在结肠镜检查期间准确评估并解除袢曲，但并未显著降低患者对镇静药物的需求，也未改善患者耐受性。不过，所使用的镇静药物剂量较小。
