镇静在结肠镜检查中的应用价值  

Application value of sedation in colonoscopy

作　　者：赵松 邓小炼 王李 叶景旺 刘正勇 高羽 黄彬 李春穴 张安平 李凡 李光焰 刘宝华 童卫东 Zhao Song;Deng Xiaolian;Wang Li;Ye Jingwang;Liu Zhengyong;Gao Yu;Huang Bin;Li Chunxue;Zhang Anping;Li Fan;Li Guangyan;Liu Baohua;Tong Weidong(Department of Gastric and Colorectal Surgery,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院胃结直肠外科,重庆400042

出　　处：《中华胃肠外科杂志》2020年第3期300-304,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然基金项目(81270461、81570483、81770541);重庆市科卫联合医疗科研项目(2018MSXM027)。

摘　　要：目的探讨镇静在结肠镜检查中的作用及其应用价值。方法采用回顾性队列研究方法。纳入标准:(1)本科室具备肠镜检查操作资格医生的内镜操作记录;(2)有完整的病历资料及结肠镜操作记录(包含文字及照片),病理报告可以追溯者。排除非本科室完成的结肠镜检查记录及资料不全者。根据以上标准,回顾性收集2007年7月至2017年2月期间,在陆军军医大学大坪医院胃结直肠外科接受结肠镜检查的门诊和住院患者共计49057例数据资料,包含所有的治疗性结肠镜检查和诊断性结肠镜检查。其中,男性24638例(50.2%),女性24419例(49.8%),年龄4~98(50.6±14.1)岁。根据患者行结肠镜检查时是否采用镇静,分为镇静组(39412例,80.3%)和非镇静组(9645例,19.7%)。比较两组结肠镜检查的临床特征。结果2007—2017年受检者选择镇静结肠镜的比例从45.6%(369/810)上升至94.8%(917/967)。两组基线资料的比较,相比非镇静组,镇静组受检者中女性比例更高[51.0%(20095/39412)比44.8%(4324/9645),χ2=117.422,P<0.001],年龄偏小[中位数50.0岁比51.0岁,Z=-4.774,P<0.001],差异均有统计学意义。而9645例非镇静组受检者中,有534例(5.5%)在检查过程中出现自觉难以忍受的腹痛而中途要求放弃检查;其中男性244例(4.6%),女性290例(6.7%),女性比例更高(χ2=20.522,P<0.001)。两组50岁以上筛查人群的息肉检出率比较,差异无统计学意义[镇静组和非镇静组分别为:26.7%(4737/17753)比27.4%(1093/3984),χ2=0.937,P=0.330];但盲肠插镜率在镇静组更高[85.2%(14422/16933)比76.1%(2803/3682),χ2=180.032,P<0.001]。镇静组出现5例医源性结肠穿孔,而非镇静组无一例出现。结论镇静在结肠镜检查中的应用日益广泛,它可以提高结肠镜检查的盲肠插镜率,但不能提高息肉检出率。镇静在增加检查费用的同时,潜在增加结肠镜穿孔发生率。Objective To investigate the value of sedation in colonoscopy.Methods A retrospective cohort study of colonoscopy procedures was performed in our institution.Inclusion criteria:(1)colonoscopy procedures were performed by well-trained gastrointestinal surgeons our institution;(2)medical records were complete and colonoscopy was documented properly by notes,videos,photographs,and traceable pathological reports.Those with incomplete records or performed in other institution were excluded.According to above criteria,clinical data of 49057 cases of clinic and hospitalization receiving diagnostic or therapeutic colonoscopyat Department of Gastric and Colorectal Surgery,Daping Hospital from July 2007 to February 2017 were collected.Among them,there were 24638(50.2%)males and 24419 females,with mean age of(50.6±14.1)(4 to 98)years.Based on the application of sedation during colonoscopy,patients were divided into the sedation group(39412 cases,80.3%)and the non-sedation group(9645 cases,19.7%).Clinical characteristics of two groups were compared.Results The sedation rate increased from 45.6%(369/810)to 94.8%(917/967)from 2007 to 2017.As compared to non-sedation group,a higher proportion of females[51.0%(20095/39412)vs.44.8%(4324/9645),χ2=117.422,P<0.001]and younger median age(50.0 years vs.51.0 years,Z=-4.774,P<0.001)were found in the sedation group,whose differences were statistically significant.In all the 9645 cases in the non-sedation group,about 5.5%(534)of them terminated the examination because of unbearable discomfort,including 244(4.6%)males and 290(6.7%)females(χ2=20.522,P<0.001).Among all the screening population who were≥50 years old,there was no significant difference in the polyp detection rate(PDR)between the sedation group and the non-sedation group[26.7%(4737/17753)vs.27.4%(1093/3984),χ2=0.937,P=0.330].The cecal intubation rate(CIR)in the sedation group was significantly higher than that in the non-sedation group[(85.2%(14422/16933)vs.76.1%(2803/3682),χ2=180.032,P<0.001].Five cases in the sedation

关 键 词：结肠镜检查 镇静 盲肠插镜率 息肉检出率 医源性结肠穿孔 

分 类 号：R57[医药卫生—消化系统]