成人胃肠内窥镜检查中静脉麻醉的选用情况及影响因素分析

Selection of intravenous anesthesia in adult gastrointestinal endoscopy and related influencing factors

目的:调查成人胃肠内窥镜检查(gastrointestinal endoscopy,GIE)中选用静脉麻醉(intravenous anesthesia,IVA)的情况及影响因素,探讨当前人群健康意识及对求医行为的影响。方法:收集2012年1月1日至2017年12月31日复旦大学附属中山医院行GIE的成人患者人口统计学资料及检查资料。分析GIE中IVA的选用率及相关影响因素。采用多因素logistic回归分析患者人口统计学因素及检查因素与选用IVA的相关性。结果:共行GIE 462251次,IVA的选用率为55.5%。非沪籍在沪有稳定工作的患者、来自高/中/低收入地区及临时在沪患者相对于沪籍患者的比值比(odds ratios,OR)分别是2.45、1.42、1.16、1.17及1.39。与18~45岁患者相比,46~65岁、66~85岁及大于85岁的OR分别是0.97、0.77和0.50。肠镜相对于胃镜OR为3.45(95%CI 3.41~3.50)。相对于健康体检,不适主诉组和术前/术后评估组的OR值分别是0.55和0.60。选用IVA相关的影响因素包括非沪籍、更低年龄、肠镜检查和健康体检。结论:非沪籍患者相对于沪籍患者更愿意自费选用IVA。高龄患者GIE中IVA的低选用率提示,此类患者存在较大的改善空间,减轻使用IVA的经济负担可能促进更多人接受GIE并选用IVA。

Objective:To determine the proportion of intravenous anesthesia(IVA)used in gastrointestinal endoscopy(GIE)and factors associated with its utilization,and to evaluate the health awareness of patients and its impact on medical treatment-seeking behavior.Methods:This retrospective,single-center study included patients aged over 18 years who underwent GIE examinations in Zhongshan Hospital,Fudan University from January 1,2012 to December 31,2017.The main parameters were the proportion of IVA utilization for gastrointestinal endoscopies and the associated factors which determined the IVA use.Logistic regression was used to explore the association between patient and procedure characteristics and utilization of IVA.Results:The average proportion of GIE with IVA use was 55.5%.Factors associated with IVA included non-Shanghai hukou(registered permanent residence)-holders(odds ratios[ORs]for non-Shanghai hukou-holders with stable jobs,patients from high,middle,low income provinces,and patients staying at Shanghai temporarily vs native Shanghai residents:2.47,1.42,1.16,1.17 and 1.39,respectively);younger age(ORs for age groups 46-65 years,66-85 years,and>85 years vs patients aged 18-45 years:0.96,0.77 and 0.50,respectively);colonoscopy(ORs for colonoscopy vs gastroscopy,3.45,95%CI 3.41-3.50);physical examination(ORs for medical complains group and pre-/post-operative evaluation group vs physical examination:0.55 and 0.60,respectively).Conclusions:Compared to Shanghai hukou-holders,non-Shanghai hukou-holders are more willing to pay for the IVA in GIE.The low selection rate of IVA in GIE of elderly patients suggests that there is much room for improvement,and reducing the economic burden of using IVA may promote more people to undergo GIE examination and choose IVA.