护士进行上消化道内镜检查：未来的发展空间？
Upper gastrointestinal endoscopy performed by nurses: scope for the future?
作者信息
Smale S, Bjarnason I, Forgacs I, Prasad P, Mukhood M, Wong M, Ng A, Mulcahy H E
机构信息
Department of Gastroenterology, King's College Hospital, Denmark Hill, London, UK.
出版信息
Gut. 2003 Aug;52(8):1090-4. doi: 10.1136/gut.52.8.1090.
BACKGROUND
Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction.
AIM
To determine differences in the yield of diagnosis for significant disease during upper gastrointestinal endoscopy performed by nurse and medical endoscopists and to measure patient discomfort, satisfaction, and attitudes towards future endoscopy.
PATIENTS
This two part study included 3009 patients in a retrospective analysis and 480 in a prospective study.
METHODS
The first part of the study assessed indications for endoscopy, diagnoses, and procedures performed by medical and nurse endoscopists. In a second prospective study, 480 patients were included to determine the association between endoscopist type and sedation, patient anxiety, discomfort, satisfaction, and attitudes towards future sedation.
RESULTS
No patient refused endoscopy by either a nurse or medical endoscopist and there were no complications in either group. Nurses performed 1487 procedures and reported fewer endoscopies as "normal" than medical staff (p=0.006). Multivariate analysis showed that male sex, older age, inpatient status, dysphagia, and gastrointestinal bleeding, but not endoscopist type, were all associated with significant disease. In relation to discomfort and satisfaction, a similar proportion of patients received sedation in both groups (p=0.81). There were no differences in pre-procedure anxiety (p=0.61), discomfort during intubation (p=0.97), discomfort during examination (p=0.90), or post-procedure examination rating (p=0.79) in patients examined by medical or nurse endoscopists.
CONCLUSION
Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff.
背景
先前的研究人员表明，非医学内镜医师进行下消化道内镜检查的安全性和有效性与医务人员相当。然而，在临床实践中，医学和非医学内镜医师进行上消化道内镜检查在操作、患者不适和满意度方面是否能产生相似的结果尚不清楚。
目的
确定护士和医学内镜医师在上消化道内镜检查中对重大疾病的诊断率差异，并衡量患者的不适、满意度以及对未来内镜检查的态度。
患者
这项两部分的研究包括回顾性分析中的3009名患者和前瞻性研究中的480名患者。
方法
研究的第一部分评估了医学和护士内镜医师进行内镜检查的指征、诊断和操作。在第二项前瞻性研究中，纳入了480名患者，以确定内镜医师类型与镇静、患者焦虑、不适、满意度以及对未来镇静的态度之间的关联。
结果
没有患者拒绝护士或医学内镜医师进行的内镜检查，两组均未出现并发症。护士进行了1487例操作，报告为“正常”的内镜检查比医务人员少（p = 0.006）。多变量分析表明，男性、年龄较大、住院状态、吞咽困难和胃肠道出血与重大疾病相关，但内镜医师类型无关。在不适和满意度方面，两组接受镇静的患者比例相似（p = 0.81）。医学或护士内镜医师检查的患者在操作前焦虑（p = 0.61）、插管期间不适（p = 0.97）、检查期间不适（p = 0.90）或操作后检查评分（p = 0.79）方面没有差异。
结论
经验丰富的护士在日常临床实践中能够安全地进行常规诊断性胃镜检查，患者的不适程度与医务人员相同，满意度也相当。
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