Park Dong I, Kim Hong J, Park Jung H, Cho Yong K, Sohn Chong I, Jeon Woo K, Kim Byung I, Ryu Seung H, Sung In K
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur J Gastroenterol Hepatol. 2007 Aug;19(8):695-9. doi: 10.1097/01.meg.0000219097.32811.24.
The actual degree of pain or discomfort experienced during colonoscopy varies between patients. This prospective study was conducted to determine what variables, apart from the endoscopist's skill, are associated with a patient's discomfort during this procedure.
DESIGN/METHODS: From December 2003 to September 2004, 646 colonoscopy examinations performed by three experienced endoscopists were analysed. Midazolam and meperidine were administered intravenously 10 min before the procedure. The degree of patient discomfort was assessed by asking more than five times during the procedure and by using a visual analogue pain scale (0-10) examined up to 7 days after the procedure. Patients were divided into sub-groups as follows: (1) comfortable group (n=304), no complaint during the procedure; and (2) uncomfortable group (n=342), more than one complaint during the procedure.
The correlation between the degree of patient discomfort and the results of the visual analogue pain scale was statistically significant (r2=0.118, P<0.01). Chi-squared analyses demonstrated that female gender, younger age (<or=40 years), presence of symptoms of inflammatory bowel syndrome, history of previous abdomino-pelvic surgery, poorer bowel preparation, longer insertion time (>480 s), technically difficult insertion, and lower body mass index (BMI) are factors associated with uncomfortable procedure. Multivariate analysis demonstrated that younger age, female gender, lower BMI, difficulty of examination, and previous gynaeco-pelvic surgery in female gender are independent factors associated with discomfort during colonoscopy.
An uncomfortable colonoscopic procedure will be expected in younger, female patients with a history of gynaeco-pelvic surgery.
结肠镜检查过程中患者实际经历的疼痛或不适程度因人而异。本前瞻性研究旨在确定除内镜医师技术外，还有哪些变量与该检查过程中患者的不适相关。
设计/方法：对2003年12月至2004年9月间由三名经验丰富的内镜医师进行的646例结肠镜检查进行分析。在检查前10分钟静脉注射咪达唑仑和哌替啶。通过在检查过程中询问五次以上以及使用视觉模拟疼痛量表（0 - 10）在检查后长达7天进行评估来评定患者不适程度。患者分为以下亚组：（1）舒适组（n = 304），检查过程中无不适主诉；（2）不舒适组（n = 342），检查过程中有不止一次不适主诉。
患者不适程度与视觉模拟疼痛量表结果之间的相关性具有统计学意义（r2 = 0.118，P < 0.01）。卡方分析表明，女性、年龄较小（≤40岁）、存在炎症性肠综合征症状、既往有腹盆腔手术史、肠道准备较差、插入时间较长（>480秒）、插入技术困难以及体重指数（BMI）较低是与检查不适相关的因素。多因素分析表明，年龄较小、女性、BMI较低、检查难度以及女性既往有妇科盆腔手术史是与结肠镜检查不适相关的独立因素。
对于有妇科盆腔手术史的年轻女性患者，预计结肠镜检查过程会不舒适。
