中文人群食管胃十二指肠镜检查中中度镇静与深度镇静的有效性、成本和安全性比较：一项准实验研究。

Comparison of effectiveness, cost and safety between moderate sedation and deep sedation under esophagogastroduodenoscopy in Chinese population: a quasi-experimental study.

机构信息

Department of Gastroenterology, Shangluo Central Hospital, Shangluo, P. R. China.

Department of Anesthesiology, Shangluo Central Hospital, Shangluo, P. R. China.

出版信息

Scand J Gastroenterol. 2022 Sep;57(9):1105-1111. doi: 10.1080/00365521.2022.2060050. Epub 2022 Apr 9.

DOI:10.1080/00365521.2022.2060050

PMID:35403537

Abstract

OBJECTIVE

Most endoscopists routinely perform moderate or deep sedation for esophagogastroduodenoscopy (EGD). Considering that there is no consensus on the optimal sedation depth and it varies from country to country, our study aims to compare the effectiveness, cost and safety of these two sedation methods in the Chinese population.

METHODS

This quasi-experimental study included a total of 556 eligible patients from July 2020 to June 2021, and they entered the moderate sedation group or deep sedation group based on their choices. Baseline information, scores of Patient Satisfaction with Sedation Instrument (PSSI) and Clinician Satisfaction with Sedation Instrument (CSSI), examination time, sedation time, recovery time, expenses before medicare reimbursement, hypoxaemia and hypotension were compared between the two groups. Propensity Score Matching (PSM) analysis was conducted to balance the confounding factors.

RESULTS

After PSM, 470 patients were involved in the analysis, with 235 for each group. The moderate sedation was clearly superior to the deep sedation group in terms of PSSI score (98.00 ± 0.94 vs. 97.29 ± 1.26), CSSI score (98.00 ± 0.78 vs. 97.67 ± 1.30), sedation time (11.90 ± 2.04 min vs. 13.21 ± 2.75 min), recovery time (25.40 ± 3.77 min vs. 28.0 ± 4.85 min), expenses (433.04 ± 0.00 Yuan vs. 789.85 ± 0.21 Yuan), with all < .001. Examination time was not significantly different between the two groups ( = .124). In addition, the moderate sedation group had a lower occurrence rate of hypoxaemia (0.36% vs. 3.27%, = .010) and hypotension (17.44% vs. 44.00%, < .001) compared to the deep sedation group.

CONCLUSIONS

Moderate sedation presented better effectiveness and safety and lower cost, and thereby it should be recommended as a widely used sedation method in clinical practice in China. This trial was registered on http://www.chictr.org.cn/index.aspx (ChiCTR2000038050).

摘要

目的

大多数内镜医师在进行食管胃十二指肠镜检查（EGD）时常规进行中度或深度镇静。考虑到对于最佳镇静深度尚无共识，并且各国之间存在差异，我们的研究旨在比较这两种镇静方法在中国人群中的有效性、成本和安全性。

方法

这项准实验研究共纳入了 2020 年 7 月至 2021 年 6 月期间的 556 名符合条件的患者，他们根据自己的选择进入中度镇静组或深度镇静组。比较两组之间的基本信息、患者镇静满意度量表（PSSI）和临床医生镇静满意度量表（CSSI）评分、检查时间、镇静时间、恢复时间、医疗保险报销前费用、低氧血症和低血压。采用倾向评分匹配（PSM）分析来平衡混杂因素。

结果

PSM 后，470 名患者纳入分析，每组 235 名。在 PSSI 评分（98.00 ± 0.94 对 97.29 ± 1.26）、CSSI 评分（98.00 ± 0.78 对 97.67 ± 1.30）、镇静时间（11.90 ± 2.04 分钟对 13.21 ± 2.75 分钟）、恢复时间（25.40 ± 3.77 分钟对 28.0 ± 4.85 分钟）、费用（433.04 ± 0.00 元对 789.85 ± 0.21 元）方面，中度镇静明显优于深度镇静组，所有差异均<0.001。两组检查时间无显著差异（ = .124）。此外，中度镇静组低氧血症发生率（0.36%对 3.27%， = .010）和低血压发生率（17.44%对 44.00%， < .001）低于深度镇静组。