1 解放军第九〇〇医院(原解放军福州总医院)暨厦门大学附属东方医院消化内科，福州 350025
|| 福建省自然科学基金 (2017J01321)。
目的：探讨结肠镜检查过程中患者疼痛相关的危险因素。方法：前瞻性收集2018年1至6月解放军第九〇〇医院门诊消化内镜室385例接受结肠镜检查患者的临床资料，采用视觉模拟评分法(Visual Analogue Scale，VAS)评估患者结肠镜检查过程中疼痛程度，自制调查问卷收集患者人口学特征、有无盆腹部手术史和结肠镜检查史、检查前有无腹痛主诉，采用综合医院焦虑/抑郁量表焦虑分量表(Anxiety Subscale of Hospital Anxiety and Depression Scale，HADS-A)评估检查前焦虑状况，渥太华肠道准备量表(Ottawa Bowel Preparation Scale，OBPS)评估肠道准备充分性，记录有无镇静及镇静方式，计算结肠镜进镜成功率(到达回盲部)，记录内镜医师经验。通过单因素和多因素logistic回归分析各个变量与结肠镜检查过程中患者疼痛的关联。结果：本组使用镇静比例为24.7%(95/385)，疼痛(VAS评分≥5)发生率为17.7%(68/385)，进镜成功率为97.4%(375/385)。单因素分析显示：结肠镜检查过程中疼痛与性别(P=0.020)、体重指数(body mass index，BMI)(P=0.006)、盆腹部手术史(P=0.010)、结肠镜检查史(P=0.034)、检查前腹痛主诉(P=0.032)、焦虑评分(P=0.017)、有无镇静(P=0.006)、镇静方式(P=0.016)、肠道准备充分性(P=0.018)、内镜医师经验(P=0.015)存在关联(均P<0.05)。多因素分析发现：低BMI(<18.5 kg/m2)(OR=1.82， 95%CI 0.67~3.53，P=0.008)、盆腹部手术史(OR=2.35，95%CI 1.48~4.76，P<0.001)、高焦虑评分(HADS -A评分≥11)(OR=2.04，95%CI 1.26~4.19，P=0.005)、未使用镇静(OR=3.16，95%CI 1.87~5.92，P<0.001)、肠道准备不充分(OBPS评分≥6)(OR=2.15，95%CI 1.54~4.06，P=0.002)、内镜医师经验少(<500例)(OR=4.76，95%CI 2.28~7.85，P<0.001)是疼痛的独立危险因素，丙泊酚镇静是疼痛的保护因素(OR=0.28，95%CI 0.15~0.62，P<0.001)。结论：结肠镜检查过程中疼痛的发生与患者自身特征、心理因素、肠道准备质量和内镜医师经验有关，对于高危人群合理使用镇静可以有效预防疼痛的发生。
Risk factors associated with self-reported pain scores during colonoscopy
CorrespondingAuthor: CHEN Xiuying
This work was supported by the Natural Science Foundation of Fujian Province, China (2017J01321).
Objective: To investigate the risk factors associated with pain in patients undergoing colonoscopy. Methods: A prospective study was conducted to collect clinical data of 385 patients undergoing colonoscopy from January 2018 to June 2018. Visual Analogue Scale (VAS) was used to assess the degree of pain during colonoscopy. A self-designed questionnaire was used to collect demographic characteristics of the patients, previous pelvic-abdominal surgery, previous colonoscopy, and complaints of abdominal pain before examination. The anxiety status before examination was assessed by the Anxiety Subscale of Hospital Anxiety and Depression Scale (HADS-A). The sedation methods were recorded. The intestinal preparation adequacy was assessed by the Ottawa Bowel Preparation Scale (OBPS). The success rate of reached caecum was recorded. The experience of endoscopists was recorded. Univariate and multivariate logistic regression were used to analyze the association between each variable and pain during colonoscopy. Results: In this series, the sedation rate was 24.7% (95/385), pain (VAS score >5) was reported by 17.7% (68/385) of patients, and success rate of endoscopy was 97.4% (375/385). Univariate analysis showed that gender (P=0.020), body mass index (BMI) (P=0.006), previous pelvic-abdominal surgery (P=0.010), previous colonoscopy (P=0.034), complaints of abdominal pain before examination (P=0.032), anxiety score (P=0.017), with or without sedation (P=0.006), sedation style (P=0.016), bowel preparation adequacy (P=0.018) and experience of endoscopists (P=0.015) were significantly associated with patient-reported pain during colonoscopy. Multivariate analysis showed that low BMI index (<18.5 kg/m2) (OR=1.82, 95% CI: 0.67–3.53, P=0.008), previous pelvic-abdominal surgery (OR=2.35, 95% CI: 1.48–4.76, P<0.001), high anxiety score (HADS-A score ≥11) (OR=2.04, 95% CI: 1.26–4.19, P=0.005), without sedation (OR=3.16, 95% CI: 1.87–5.92, P<0.001), inadequate bowel preparation (OBPS score >6) (OR=2.15, 95% CI: 1.54–4.06, P=0.002), limited experience of endoscopists (<500 cases) (OR=4.76, 95% CI: 2.28–7.85, P<0.001) were independent risk factors of patient-reported pain. The propofol sedation was the protective factor of patient-reported pain (OR=0.28, 95% CI: 0.15–0.62, P<0.001). Conclusion: The occurrence of pain during colonoscopy is related to the patient’s own characteristics, psychological factors, the quality of bowel preparation and the operator’s experience. Rational use of sedation for high-risk groups can effectively prevent the occurrence of pain during colonoscopy.
colonoscopy; pain; conscious sedation; propofol