Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
Division of Gastroenterology, Department of Internal Medicine, Saga University, Saga, 849-8501, Japan.
BMC Gastroenterol. 2022 Nov 4;22(1):445. doi: 10.1186/s12876-022-02549-7.
This study aimed to evaluate the usefulness of discharge standards in outpatients undergoing sedative endoscopy by comparing the modified post-anesthetic discharge scoring system (MPADSS) and the modified Aldrete score.
We prospectively enrolled 376 outpatients who underwent gastrointestinal endoscopy under midazolam sedation; 181 outpatients were assessed regarding discharge after sedative endoscopy using the MPADSS (group M), and 195 patients were assessed by the modified Aldrete score (group A). The clinical characteristics, types of endoscopy, endoscopic outcomes, and anesthesia outcomes were evaluated between the two groups. We compared discharge score, recovery time, and adverse events using propensity-score matching.
Propensity-score matching created 120 matched pairs. The proportion of patients who had a recovery time within 60 min after endoscopy was significantly higher in group A than that in group M (42.5% versus 25.0%, respectively; P < 0.01). The proportion of patients who required > 120 min of recovery time after endoscopy was significantly lower in group A than that in group M (0.0% versus 5.0%, respectively; P = 0.03). However, significantly more patients had drowsiness at discharge in group A compared with group M (19.1% versus 5.0%, respectively; P < 0.01). There was no significant difference in the adverse event rate within 24 h of discharge between the groups.
Patients assessed by the modified Aldrete score were allowed to discharge earlier than those assessed by the MPADSS. However, a patient's level of consciousness should be assessed carefully, especially in patients who visit the hospital alone.
本研究旨在通过比较改良麻醉后出院评分系统（MPADSS）和改良 Aldrete 评分，评估门诊镇静内镜患者出院标准的实用性。
我们前瞻性纳入 376 例接受咪达唑仑镇静下胃肠内镜检查的门诊患者；181 例患者采用 MPADSS（M 组）评估镇静内镜后出院，195 例患者采用改良 Aldrete 评分（A 组）评估。评估两组的临床特征、内镜类型、内镜结果和麻醉结果。我们使用倾向评分匹配比较出院评分、恢复时间和不良事件。
倾向评分匹配创建了 120 对匹配组。A 组内镜后 60 分钟内恢复时间的患者比例明显高于 M 组（42.5%对 25.0%；P<0.01）。A 组内镜后需要>120 分钟恢复时间的患者比例明显低于 M 组（0.0%对 5.0%；P=0.03）。然而，A 组出院时嗜睡的患者明显多于 M 组（19.1%对 5.0%；P<0.01）。两组出院后 24 小时内不良事件发生率无显著差异。
采用改良 Aldrete 评分评估的患者比采用 MPADSS 评估的患者更早出院。然而，应仔细评估患者的意识水平，尤其是独自就诊的患者。
