笑气清醒镇静镇痛结肠镜检查舒适度的影响因素分析

Risk factors affecting patient comfort in nitrous oxide inhalation-induced conscious sedation status during colonoscopy

目的评价笑气清醒镇静镇痛结肠镜检查的舒适度，并探讨影响舒适度的因素。方法2016年10月至2017年7月，154例行结肠镜检查患者纳入研究，采用MGCS分级标准评价患者的舒适度，运用单因素分析及二分类多因素logistic回归分析方法分析舒适度的影响因素，并建立函数预测模型。结果154例均顺利完成结肠镜检查，患者达到笑气化状态的平均时间为195.15 s，其中舒适（MGCS分级1-3级）者115例（74.7%），不舒适（MGCS分级4-5级）者39例（25.3%）。二分类logistics回归分析结果显示，年龄≥60岁（P=0.000，OR=1.074，95%CI：1.036-1.114）、检查前焦虑（P=0.018，OR=3.338，95%CI：1.227-9.079）是影响笑气清醒镇静镇痛结肠镜检查舒适度的独立危险因素。以年龄（X1）、检查前焦虑（X2）为自变量建立的函数预测模型为P=eY/（1＋eY），Y=－3.812＋0.071X1＋1.205X2（无焦虑赋值1，有焦虑赋值2）,所得受试者工作特征曲线下面积为0.746（95%CI：0.661-0.830），模型判断的有效性为中等，当约登指数最大时（P=0.838），判断准确性最高，敏感度为50.4%，特异度为89.7%。结论结肠镜检查采用笑气清醒镇静镇痛能有效改善患者的舒适度，对于高龄（≥60岁）以及检查前焦虑的患者，临床上可以根据实际情况选择性使用。

ObjectiveTo evaluate the effects of nitrous oxide inhalation on conscious sedation of patients during colonoscopy and analyze its risk factors.MethodsFrom October 2016 to July 2017, a total of 154 patients undergoing colonoscopy were included in the study. The comfort level was rated using Modified Gloucester Comfort Scale （MGCS）. Factors affecting comfort level were analyzed by univariate analysis and multivariate Logistic regression, and then a comfort stratification predicting model was created.ResultsAll 154 patients finished colonoscopy. The mean time of ideal anesthesia state was 195.15 s. Among the 154 cases, 115 （74.7%） were identified as comfort （grade of MGCS from 1 to 3） and 39 （25.3%） were rated as discomfort （grade of MGCS from 4 to 5）. Multivariate regression indicated that age ≥60 years （P=0.000, OR=1.074, 95%CI： 1.036-1.114） and mild anxiety （P=0.018, OR=3.338, 95%CI： 1.227-9.079） were associated with comfort level during colonoscopy. The established model with the age （X1） and mild anxiety （X2） was P=eY/（1＋ eY）, Y=-3.812＋ 0.071X1＋ 1.205X2（no anxiety was assigned 1, mild anxiety was assigned 2）, and the area under the receiver operating characteristics curve was 0.746 （95%CI： 0.661-0.830）, which showed moderate predictive power of the final model. The model reached the highest predictive accuracy when the Yoden Index was 0.838 with sensitivity of 50.4% and specificity of 89.7% for predicting comfort level of patients in conscious sedation status induced by nitrous oxide inhalation during colonoscopy.ConclusionNitrous oxide can ease pain during colonoscopy, especially for patients over 60 years old and with anxiety. We can use it as an option according to actual circumstance in practice.