Department of Gastroenterology, Northern General Hospital, Sheffield, UK.
Eur J Gastroenterol Hepatol. 2009 Sep;21(9):1076-82. doi: 10.1097/MEG.0b013e32832357b3.
Colonoscopy can be uncomfortable. To increase safety, there is a trend, in the UK, towards reduced sedative use. We aimed to determine factors predictive of discomfort during colonoscopy.
Prospectively recruited patients were asked to grade anticipated discomfort on a Numeric Rating Scale ranging from 0 to 10. Discomfort scores were recorded every 2 min during the procedure and during peaks of discomfort. An overall discomfort score was recorded.
One hundred and nine patients [44 male, 65 female; median 61.5 (21-80) years] were recruited. One hundred and three procedures were completed. Forty-five patients received midazolam [median 2 (1.5-5) mg]. Mean overall Numeric Rating Scale score was 4.7 (men 4.0; women 5.2; P<0.01) and median peak score 7. Discomfort was usually greatest at the beginning of the procedure, while in the sigmoid colon. Discomfort scores were higher in patients with irritable bowel syndrome (P = 0.03); diverticular disease (P<0.01); midazolam (P = 0.02), buscopan (P<0.001) or nitrous oxide (P<0.001) use; endoscope tracker use (P = 0.01); incomplete procedures (P<0.001) or a preceding gastroscopy (P = 0.02), but were not correlated with discomfort during venous cannulation or digital rectal examination. Multivariate analysis showed that female sex, high anxiety, anticipation of high discomfort, longer intubation time and higher endoscopist's grade of procedural difficulty were independent factors significantly related to overall discomfort scores. Recollected discomfort scores 2-3 months later were lower (P<0.01). Low-dose midazolam had no appreciable amnesic effect.
Factors indicative of difficult colonoscopy, and preceding gastroscopy, are associated with greater discomfort, as are the presence of female sex, irritable bowel, anxiety and anticipated discomfort. Low-dose midazolam neither relieves discomfort nor makes patients forget it. Selected patients may benefit from increased analgesia.
结肠镜检查可能会带来不适。为了提高安全性，在英国，人们倾向于减少镇静剂的使用。本研究旨在确定预测结肠镜检查过程中不适的因素。
前瞻性招募的患者使用数字评分量表（NRS）对预期不适程度进行评分，范围为 0-10 分。在检查过程中每 2 分钟记录一次不适评分，并记录不适峰值时的评分。记录总体不适评分。
共招募 109 例患者[44 例男性，65 例女性；中位年龄 61.5（21-80）岁]。103 例完成检查。45 例患者接受咪达唑仑镇静[中位剂量 2（1.5-5）mg]。平均 NRS 总体评分 4.7（男性 4.0；女性 5.2；P<0.01），中位数峰值评分 7。不适通常在检查开始时和乙状结肠部位最为严重。在患有肠易激综合征（P = 0.03）、憩室病（P<0.01）、咪达唑仑（P = 0.02）、丁溴东莨菪碱（P<0.001）或笑气（P<0.001）、内镜跟踪器（P = 0.01）使用、检查不完整（P<0.001）或先前行胃镜检查（P = 0.02）的患者中，不适评分较高，但与静脉穿刺或直肠指检期间的不适无关。多因素分析显示，女性、高焦虑、预期高不适、更长的插管时间和更高的内镜医师操作难度评分是与总体不适评分显著相关的独立因素。2-3 个月后回忆的不适评分较低（P<0.01）。小剂量咪达唑仑无明显记忆缺失作用。
预示结肠镜检查困难的因素，以及先前的胃镜检查，与更大的不适相关，女性、肠易激综合征、焦虑和预期不适也是如此。小剂量咪达唑仑既不能缓解不适，也不能使患者忘记不适。选择合适的患者可能受益于增加镇痛。
