Stefano Pontone, PhD, MD, Department of Surgical Sciences, Sapienza University, Rome, Italy.
Rossella Palma, MD, Department of Surgical Sciences, Sapienza University, Rome, Italy.
Gastroenterol Nurs. 2020 May/Jun;43(3):258-263. doi: 10.1097/SGA.0000000000000456.
Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam-meperidine or midazolam-fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.
哌替啶和芬太尼是目前在意大利用于结肠镜检查镇静和镇痛的阿片类药物，除了咪达唑仑。本研究的目的是评估患者在选择性结肠镜检查前的心理状态对镇静方案疗效的影响。我们的研究纳入了 80 名接受选择性结肠镜检查的门诊患者。通过自我管理医院焦虑和抑郁量表问卷评估基础焦虑和抑郁状态。通过标准的 100 毫米视觉模拟量表评估基线不适率。镇静作用分别通过咪达唑仑-哌替啶或咪达唑仑-芬太尼联合用药获得。芬太尼组和哌替啶组在体重指数、年龄和性别构成方面无统计学差异。哌替啶组患者在结肠镜检查期间的疼痛程度低于芬太尼组。哌替啶组的痛苦、焦虑和抑郁呈统计学显著正相关。我们的研究指出，咪达唑仑加哌替啶方案的效果更好，恢复时间相同，内镜检查时间无显著差异。当疼痛的伤害感受成分得到很好的控制时，评估患者的心理状态似乎可以预测镇静的效果。
