无痛胃镜与常规胃镜检查的前瞻性对照研究

目的探讨临床上无痛胃镜和常规胃镜检查的取舍原则。方法连续选择自愿接受无痛胃镜检查（无痛胃镜组）和常规胃镜检查（普通胃镜组）的患者各400例，检查结束后完成f可卷调查，统计分析2组检查完成情况、操作时间、检查费用以及问卷调查结果。结果无痛胃镜组和普通胃镜组检查完成率分别为100．0％（400／400）和98．0％（392／400）（P=0．004），操作时间分别为（257．7-I-133．5）S和（214．2±121．3）S（P〈0．001），平均检查费用分别为人民币574．23形人和268．00形人（P〈0．001），患者满意度评分分别为4（3～4）分和3（2～3）分（Z=一18．98，P〈0．001），操作者满意度评分均为4（4～4）分（Z=一2．645，P=0．008），胃镜检查摄片质量评分分别为（3．13±0．39）分和（3．18±0．50）分（P=0．153）。无痛胃镜组术中有20例（5．0％）发生SpO：下降，既往心血管疾病病史（OR=2．410，95％CI：0．924—6．287，P=0．004）和患者年龄（OR=1．039，95％CI：1．002一I．077，P=0．002）与发生Sp02下降存在关联。无痛胃镜组和普通胃镜组分别有381例（95．2％）和145例（36．4％）（P〈0．001）愿意再次接受相同检查方式检查，其中普通胃镜组男性（P=0．007）、年龄1〉60岁者（P=0．031）、体质量指数≤24kg／m2者（P=0．039）更愿意再次接受常规胃镜检查。结论在中国目前，由于完成率高、检查时间短、费用低，常规胃镜检查仍是上消化道疾病检查不可欠缺的重要方法。内镜医师在建议患者选择胃镜检查方式时，不仅要考虑减轻患者检查中的不适程度，更要根据患者的实际情况，严格把握适应证，在充分利用医疗资源的前提下使患者得到及时的诊治。

Sedated versus conventional upper gastrointestinal endoscopy： a prospective study on patient accept- ability and satisfaction

Objective To explore the clinical choice principles of sedated upper gastrointestinal （GI） endoscopy versus conventional upper gastrointestinal （GI） endoscopy. Methods Sedated GI endos- copy group （n = 400 ） and conventional GI endoscopy group （n = 400） were respectively set up with patients who had undergone the two procedures from May 13 to July 29, 2013. All patients and endoseopists were asked to fill out a self-administered questionnaire about procedure-related discomfort, patient satisfaction and endoseopist satisfaction with endoscopy, and the endoscopic image score. Patients were also asked about whether they would opt for the identical upper GI endoscopy again in the future if required. The endoscopy completion, operation time, and questionnaire results of the two groups were compared and statistically ana- lyzed. Results The completion rates were 100.0% （400/400） and 98. 0% （392/400） in the sedated GI endoscopy group and the conventional GI endoscopy group, respectively （ P = 0. 004 ）. The operation times of sedated and conventional group were （ 257.7 133.5 ） s and （ 214.2 ± 121.3 ） s respectively （ P 〈0. 001 ）. And the mean cost was CNY 574. 23 and CNY 268. O0 per patient in sedated and the conventional group,respectively. Patient satisfaction scores of conventional group and sedated group were 3 （2 3 ） and 4 （3 4） respectively （Z = - 18. 98, P 〈 0. 001 ）, while endoscopist satisfaction was both 4 （4 - 4） in two groups （ Z = - 2. 645 ,P = 0. 008 ）. The endoscopic image scores were （ 3.13 ＋ 0. 39 ） points and （ 3.18 ＋ 0. 50） points for sedated and conventional group （P = 0. 153 ） , respectively. SpO2 of 20 patients （5.0%） in the sedated group decreased during the procedure. Binary logistic regression analysis predicted correlated factors for a decreased SpO2 in the SES of identified cardiovascular disorders （P = 0. 004, OR = 2. 410,95% CI：O. 924 6. 287） and older age （ P = 0. 002, OR = 1. 039,95 % CI： 1. 002 - 1. 077 ）. A total of 381 pa- tients （95.2%） in the sedated group and 145 patients （36.4%） in the conventional group showed willing- ness to accept the identical upper GI endoscopy again （ P 〈 0. 001 ）. Males （ P = 0. 007） aged above 60 （ P = 0. 031 ） and BMI 〈24 kg/m2 （P = 0. 039） in the conventional group were more willing to repeat conven- tional GI endoscopy. Conclusion Conventional GI endoscopy remains an indispensable examination of up- per gastrointestinal disease in China due to its high completion rates, shorter procedure time and lower cost. Physicians should not only focus on patients＇ comfort during endoscopy, but also help patients make a bal- anced decision based on their actual situation and endoscopic indications.