Trevisani Lucio, Sartori Sergio, Gaudenzi Piergiorgio, Gilli Giuseppe, Matarese Giancarlo, Gullini Sergio, Abbasciano Vincenzo
Digestive Endoscopy Service, Department of Internal Medicine, S. Anna Hospital, Ferrara, Italy.
World J Gastroenterol. 2004 Nov 15;10(22):3313-7. doi: 10.3748/wjg.v10.i22.3313.
The fears and concerns are associated with gastroscopy (EGD) decrease patient compliance. Conscious sedation (CS) and non-pharmacological interventions have been proposed to reduce anxiety and allow better execution of EGD. The aim of this study was to assess whether CS, supplementary information with a videotape, or presence of a relative during the examination could improve the tolerance to EGD.
Two hundred and twenty-six outpatients (pts), scheduled for a first-time non-emergency EGD were randomly assigned to 4 groups: Co-group (62 pts): throat anaesthesia only; Mi-group (52 pts): CS with i.v. midazolam; Re-group (58 pts): presence of a relative throughout the procedure; Vi-group (54 pts): additional information with a videotape. Anxiety was measured using the "Spielberger State and Trait Anxiety Scales". The patients assessed the overall discomfort during the procedure on an 100-mm visual analogue scale, and their tolerance to EGD answering a questionnaire. The endoscopist evaluated the technical difficulty of the examination and the tolerance of the patients on an 100-mm visual analogue scale and answering a questionnaire.
Pre-endoscopy anxiety levels were higher in the Mi-group than in the other groups (P<0.001). On the basis of the patients' evaluation, EGD was well tolerated by 80.7% of patients in Mi-group, 43.5% in Co-group, 58.6% in Re-group, and 50% in Vi-group (P<0.01). The discomfort caused by EGD, evaluated by either the endoscopist or the patients, was lower in Mi-group than in the other groups. The discomfort was correlated with "age" (P<0.001) and "groups of patients" (P<0.05) in the patients' evaluation, and with "gender" (females tolerated better than males, P<0.001) and "groups of patients" (P<0.05) in the endoscopist's evaluation.
Conscious sedation can improve the tolerance to EGD. Male gender and young age are predictive factors of bad tolerance to the procedure.
与胃镜检查（上消化道内镜检查，EGD）相关的恐惧和担忧会降低患者的依从性。已提出使用清醒镇静（CS）和非药物干预措施来减轻焦虑并使EGD检查能更好地进行。本研究的目的是评估CS、录像带补充信息或检查期间亲属在场是否能提高对EGD的耐受性。
226例计划进行首次非急诊EGD的门诊患者被随机分为4组：对照组（62例患者）：仅行咽喉麻醉；咪达唑仑组（52例患者）：静脉注射咪达唑仑进行CS；亲属组（58例患者）：整个操作过程中有亲属在场；录像带组（54例患者）：通过录像带提供额外信息。使用“斯皮尔伯格状态和特质焦虑量表”测量焦虑程度。患者在100毫米视觉模拟量表上评估操作过程中的总体不适程度，并通过回答问卷评估他们对EGD的耐受性。内镜医师在一个100毫米视觉模拟量表上评估检查过程的技术难度以及患者的耐受性，并回答一份问卷。
咪达唑仑组内镜检查前的焦虑水平高于其他组（P<0.001）。根据患者的评估，咪达唑仑组80.7%的患者对EGD耐受性良好，对照组为43.5%，亲属组为58.6%，录像带组为50%（P<0.01）。内镜医师或患者评估显示，咪达唑仑组EGD引起的不适低于其他组。在患者评估中，不适与“年龄”（P<0.001）和“患者组”（P<0.05）相关，在内镜医师评估中，与“性别”（女性耐受性优于男性，P<0.001）和“患者组”（P<0.05）相关。
清醒镇静可提高对EGD的耐受性。男性和年轻是该操作耐受性差的预测因素。
