Ball Alex J, Rees Colin J, Corfe Bernard M, Riley Stuart A
aDepartment of Gastroenterology, Sheffield Teaching Hospitals bDepartment of Oncology, University of Sheffield, Medical School cSouth Yorkshire and Bassetlaw Bowel Cancer Screening Centre, Sheffield Teaching Hospitals, Sheffield dSouth of Tyne Bowel Cancer Screening Centre, South Tyneside General Hospital, South Shields eDurham University School of Medicine, Pharmacy and Health, Durham, UK.
Eur J Gastroenterol Hepatol. 2015 Jun;27(6):741-6. doi: 10.1097/MEG.0000000000000360.
Medication may be used to manage discomfort during colonoscopy but practice varies. The relationship between medication use and comfort during colonoscopy was examined in the English Bowel Cancer Screening Programme.
Data related to patient comfort and medication use from all 113,316 examinations performed within the English Bowel Cancer Screening Programme between 1 January 2010 and 31 December 2012 were analysed. Comfort was rated on the five-point Modified Gloucester Comfort Scale: 1, no discomfort; 5, severe discomfort. Scores of 4 and 5 were considered to indicate significant discomfort. Correlations between the proportion of examinations associated with significant discomfort and the amounts of medication used by colonoscopists were assessed using Spearman's ρ. Logistic regression modelling examined the independent predictors of significant discomfort.
Patients had a mean age of 65.7 years, and 58% were male. Examinations were performed by 290 endoscopists. In 91% of examinations, there was no significant discomfort reported during examination; however, there was considerable variation between individual colonoscopists (range 76.1-99.2%).Intravenous sedation and opiate analgesia were used during most examinations, but there was wide variation between colonoscopists, with a median (range) usage of 95.1% (4.1-100%) and 97.3% (5.6-100%), respectively. There was no association between the amount of sedation and analgesia used and significant discomfort (ρ<0.2). On multivariate analysis, significant discomfort was found to be more common among female individuals [odds ratio (OR)=2.0], on incomplete examinations (OR=6.7), and among patients with diverticulosis (OR=1.4).
There was wide variation in medication practice among English screening colonoscopists, but this was unrelated to the occurrence of significant discomfort.
结肠镜检查期间可使用药物来缓解不适，但实际操作存在差异。在英国肠癌筛查项目中，对药物使用与结肠镜检查期间舒适度之间的关系进行了研究。
分析了2010年1月1日至2012年12月31日在英国肠癌筛查项目中进行的所有113316例检查中与患者舒适度和药物使用相关的数据。舒适度采用五点改良格洛斯特舒适度量表进行评分：1分，无不适；5分，严重不适。4分和5分被视为表示有明显不适。使用Spearman's ρ评估与明显不适相关的检查比例与结肠镜检查医生使用的药物量之间的相关性。逻辑回归模型研究了明显不适的独立预测因素。
患者的平均年龄为65.7岁，58%为男性。检查由290名内镜医师进行。在91%的检查中，检查期间未报告明显不适；然而，个体结肠镜检查医生之间存在相当大的差异（范围为76.1 - 99.2%）。大多数检查使用了静脉镇静和阿片类镇痛药物，但结肠镜检查医生之间差异很大，中位（范围）使用率分别为95.1%（4.1 - 100%）和97.3%（5.6 - 100%）。使用的镇静和镇痛药物量与明显不适之间无关联（ρ<0.2）。多因素分析发现，明显不适在女性个体中更常见[比值比（OR）=2.0]，在检查不完全的患者中更常见（OR = 6.7），在患有憩室病的患者中更常见（OR = 1.4）。
英国筛查结肠镜检查医生的药物使用实践存在很大差异，但这与明显不适的发生无关。
