Usui Yusuke, Miyoshi Shion, Nakamura Yasuhiko, Shimizu Hiroshige, Sekiya Muneyuki, Urabe Naohisa, Isshiki Takuma, Sakamoto Susumu, Homma Sakae, Kishi Kazuma
Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, JPN.
Cureus. 2025 May 2;17(5):e83331. doi: 10.7759/cureus.83331. eCollection 2025 May.
The distress experienced by patients during bronchoscopy is often more severe than bronchoscopists anticipate. However, the use of sedatives during bronchoscopy varies depending on the facility, which may be insufficient. We examined the accuracy of bronchoscopist evaluation of predicted patient discomfort during bronchoscopy under intravenous sedation.
This study retrospectively reviewed 186 consecutive patients who underwent bronchoscopy between December 2018 and April 2019. Ultimately, 113 patients who underwent bronchoscopy with pethidine (meperidine) and 64 patients who underwent bronchoscopy with pethidine and midazolam were assigned to the pethidine group and the pethidine with midazolam combination group, respectively. We compared the patient self-assessed discomfort scores (obtained after recovery from sedation) with the discomfort scores predicted by bronchoscopists, using a five-point rating scale in each sedation group. Any discrepancy was then evaluated.
The pethidine group had significantly higher self-assessed patient discomfort scores than the predictive assessment by bronchoscopists (mean score 3.4±1.3 vs. 2.9±1.2; P< 0.001). Conversely, the pethidine with midazolam group had a significantly lower self-assessed patient discomfort score than the bronchoscopists' predictive assessment (mean score 2.4±1.5 vs. 3.3±1.4; P 0.001). Multivariate analysis identified the use of midazolam as a significant factor affecting patient discomfort (odds ratio: 0.176, P < 0.001) in addition to hypoxia during bronchoscopy (odds ratio: 3.331, P = 0.008).
Bronchoscopists may underestimate patient discomfort during bronchoscopy under intravenous sedation. The use of midazolam was an important factor affecting the patient's discomfort during bronchoscopy.
支气管镜检查期间患者所经历的痛苦往往比支气管镜检查医生预期的更为严重。然而，支气管镜检查期间镇静剂的使用因机构而异，可能并不充分。我们研究了支气管镜检查医生在静脉镇静下对患者支气管镜检查期间预期不适评估的准确性。
本研究回顾性分析了2018年12月至2019年4月期间连续接受支气管镜检查的186例患者。最终，113例接受哌替啶（度冷丁）支气管镜检查的患者和64例接受哌替啶和咪达唑仑支气管镜检查的患者分别被分配到哌替啶组和哌替啶与咪达唑仑联合组。我们在每个镇静组中使用五点评分量表，将患者自我评估的不适评分（镇静恢复后获得）与支气管镜检查医生预测的不适评分进行比较。然后评估任何差异。
哌替啶组患者自我评估的不适评分显著高于支气管镜检查医生的预测评估（平均评分3.4±1.3对2.9±1.2；P<0.001）。相反，哌替啶与咪达唑仑组患者自我评估的不适评分显著低于支气管镜检查医生的预测评估（平均评分2.4±1.5对3.3±1.4；P<0.001）。多变量分析确定，除支气管镜检查期间的低氧血症（优势比：3.331，P = 0.008）外，咪达唑仑的使用是影响患者不适的一个重要因素（优势比：0.176，P < 0.001）。
支气管镜检查医生可能低估了静脉镇静下支气管镜检查期间患者的不适。咪达唑仑的使用是影响支气管镜检查期间患者不适的一个重要因素。
