The impact of sedation on quality metrics of colonoscopy: a single-center experience of 48,838 procedures
The impact of sedation on quality metrics of colonoscopy: a single-center experience of 48,838 procedures
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镇静对结肠镜检查质量指标的影响：48,838 例手术的单中心经验
DOI：
10.1007/s00384-020-03586-y
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发表时间：
2020-06-01
影响因子：
2.8
通讯作者：
Tong, Wei-dong
中科院分区：
文献类型：
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作者：
Zhao, Song;Deng, Xiao-lian;Tong, Wei-dong
研究镇静在结肠镜检查中的作用是有意义的，因为镇静在结肠镜检查中的优势仍然存在争议。方法回顾分析我所接受结肠镜检查的患者的病历。统计镇静率、腺瘤发现率(ADR)、息肉发现率(PDR)、盲肠插管率(CIR)、医源性结肠穿孔率(ICP)。年龄中位数为50岁(16-85岁)。总镇静率为80.38%。PDR为26.77%，有无镇静的结肠镜检查无统计学差异(26.67%vs27.22，p= 0.474)。无论是否应用镇静，不良反应发生率均为12.9%(13.0%vs12.44%，p= 0.337)。所有检查的CIR为87.42%，调整后的CIR为90.34%，镇静时的CIR高于不镇静时的CIR(88.92%比80.64%，p<； 0.0001)。5例(0.01%)患者均发生在镇静状态下。结论镇静剂的使用与CIR增加有关，但ADR和PDR在镇静或不镇静的情况下无明显变化。然而，尽管穿孔率很低，但镇静剂患者的穿孔率明显较高。
PurposeInvestigation of the role of sedation during colonoscopy is meaningful as the advantages of colonoscopy performing with sedation are still controversial.MethodsMedical records of patients who underwent colonoscopy in our institution were retrospectively analyzed. The sedation rate, adenoma detection rate (ADR), polyp detection rate (PDR), cecal intubation rate (CIR), iatrogenic colonic perforation rate (ICP) were calculated.ResultsA total of 48,838 colonoscopies (24,498 in males) dated from July 2007 to February 2017 were analyzed. The median age was 50 years (range 16–85 years). An overall sedation rate was 80.38%. The PDR was 26.77%, and was not statistically different between colonoscopy with or without sedation (26.67% vs 27.22,p= 0.474). ADR was 12.9% regardless of applying sedation or not (13.0% vs 12.44%,p= 0.337). The CIR was 87.42% in all examinations with an adjusted CIR of 90.34%, and was higher when performed with sedation than without sedation (88.92% vs 80.64%,p< 0.0001). Five cases (0.01%) of ICP were reported, all of which occurred in patients under sedation.ConclusionsThe use of sedation is associated with increased CIR, but ADR and PDR remain unchanged with or without sedation. However, perforation rate, albeit very low, is significantly higher in sedated patients.