Takahashi Yuuichi, Tanaka Hideaki, Kinjo Mitsuyo, Sakumoto Ken
Division of Gastroenterology and Endocrinology, Department of Medicine, Tomishiro Chuo Hospital, Okinawa, Japan.
Dis Colon Rectum. 2005 Apr;48(4):855-9. doi: 10.1007/s10350-004-0860-0.
The administration of sedative drugs at colonoscopy has its drawbacks, such as increasing the rate of complications and the cost. There are a number of potential advantages to performing colonoscopy without sedation. The aim of this study is to evaluate patient tolerance and acceptance during sedation-free colonoscopy.
Pain during sedation-free colonoscopy was evaluated in consecutive series of 675 patients in a prospective manner from January 1, 2003, to February 18, 2004. We recorded the degree of patient pain during colonoscopy, willingness to undergo sedation-free colonoscopy in the future, the complication rate, and the intubation time. The assisting endoscopy nurses and patients independently assessed the pain level immediately after the procedure using a four-point pain scale (nil, mild, moderate, severe).
Almost all colonoscopies (99.6 percent: 672/675) were successful. There were four complications related to colonoscopy (bleeding after polypectomy). Patients and nurses rated pain by a four-point pain scale as follows. For the patients: nil, 69.6 percent (470/675); mild, 28.0 percent (189/675); moderate, 2.2 percent (15/675); severe, 0.1 percent (1/675). For the nurses: nil, 76.1 percent (514/675); mild, 22.7 percent (153/675); moderate, 0.9 percent (6/ 675); severe, 0.3 percent (2/675). Patients rarely suffered from severe pain during carefully performed colonoscopies. The pain level of almost all colonoscopies was acceptable by patients, with only six patients (1.0 percent) stating that they would never undergo a colonoscopy without sedation in the future because of unbearable pain.
This study suggests that carefully performed sedation-free colonoscopy rarely causes complications and is well accepted by most patients. Sedation-free colonoscopy is more cost-effective, may be safer, and should be offered as an alternative to colonoscopy with sedation.
在结肠镜检查时使用镇静药物存在诸多弊端，如增加并发症发生率及成本。非镇静状态下进行结肠镜检查有许多潜在优势。本研究旨在评估非镇静结肠镜检查期间患者的耐受性和接受度。
前瞻性地评估了2003年1月1日至2004年2月18日连续675例患者在非镇静结肠镜检查期间的疼痛情况。我们记录了结肠镜检查期间患者的疼痛程度、未来接受非镇静结肠镜检查的意愿、并发症发生率及插管时间。辅助内镜检查的护士和患者在检查结束后立即使用四点疼痛量表（无、轻度、中度、重度）独立评估疼痛程度。
几乎所有结肠镜检查（99.6%：672/675）均成功。有4例与结肠镜检查相关的并发症（息肉切除术后出血）。患者和护士使用四点疼痛量表对疼痛的评级如下。患者：无，69.6%（470/675）；轻度，28.0%（189/675）；中度，2.2%（15/675）；重度，0.1%（1/675）。护士：无，76.1%（514/675）；轻度，22.7%（153/675）；中度，0.9%（6/675）；重度，0.3%（2/675）。在仔细进行的结肠镜检查过程中，患者很少遭受严重疼痛。几乎所有结肠镜检查的疼痛程度患者均可接受，只有6例患者（1.0%）表示因疼痛难以忍受，未来再也不会接受非镇静结肠镜检查。
本研究表明，仔细进行的非镇静结肠镜检查很少引起并发症，且为大多数患者所接受。非镇静结肠镜检查更具成本效益，可能更安全，应作为镇静结肠镜检查的替代方法提供给患者。
