- 學位論文
左臥姿和坐姿施行經鼻上消化道內視鏡檢查之差異
Difference between left decubitus and sitting transnasal upper gastrointestinal endoscopy
摘要
研究背景： 在現代消化學中，上消化道內視鏡檢查已是診斷及治療上消化道疾病之重要的低侵襲性方法，但也由於檢查所帶來的不適，常使病患裹足不前。如何降低上消化道內視鏡檢查的不舒服，並且不影響檢查之診斷及治療品質成為一項重要課題。有許多可能行得通的方法被提出，包括各種麻醉下進行、膠囊內視鏡、虛擬內視鏡、細徑內視鏡，其中細徑內視鏡為最便宜可行。和麻醉下進行之傳統經口上消化道內視鏡相比，未麻醉經鼻細徑上消化道內視鏡有不相上下之整體滿意度、且有較短之恢復時間、較快返回工作崗位、醫療費用較少；和未麻醉經口細徑上消化道內視鏡相比，未麻醉經鼻細徑上消化道內視鏡病患較能忍受、且未來若需要病患較願意以同樣方法檢查、及較低交感神經興奮度。 耳鼻喉科醫師是讓病患以坐姿來施行鼻咽鏡，病患可監看螢幕，了解醫師正在進行步驟，應有較高之安全感。因此本研究試著探討若以坐姿來施行未麻醉經鼻細徑上消化道內視鏡檢查是否比左側躺來施行有較高之病患滿意度。 研究方法與材料: 以台中一家區域級教學醫院一般肝膽胃腸科門診病人中，年齡介於18歲至70歲之間且因上腹痛、貧血、胃酸逆流或胸口痛…等符合診斷性上消化道內視鏡檢查條件者且第一次接受上消化道內視鏡者，隨機分成實驗組－坐姿來施行未麻醉經鼻細徑上消化道內視鏡檢查，及控制組－以左臥姿來施行未麻醉經鼻細徑上消化道內視鏡檢查。主要結果是比較兩組病患對於檢查之疼痛指數。次要結果是比較兩組病患檢查時間。 結果與發現: 在民國九十七年十月至民國九十八年三月之間，一共收集到85例病患，其中有43例接受坐姿檢查，有42例接受左臥姿檢查。在病患基本背景資料、檢查結果、檢查適應症兩組均無差別。在疼痛指數方面，坐姿組為3.11±2.69，而左臥姿組為2.59±2.54， p=.371，兩組疼痛指數無統計上的差別。在檢查所需時間方面，坐姿組所需時間為276±107秒，而左臥姿組所需時間為184±49秒，坐姿組較左臥姿組費時，達到統計學上有意義（p=.000）。當兩組均排除接受幽門桿菌檢查或切片之病例時，檢查所需時間坐姿組仍比左臥姿組費時（245±63秒v.s. 179±57秒），也達到統計學上有意義（p=.002）。 結論: 本研究顯示在ㄧ般肝膽胃腸科門診需施行上消化道內視鏡檢查病患中以坐姿來施行經鼻上消化道內視鏡檢查比傳統以左臥姿施行經鼻上消化道內視鏡檢查並未有較佳之病患滿意度，且較耗時。
並列摘要
Title: Difference between left decubitus and sitting transnasal upper gastrointestinal endoscopy Background: In modern gastroenterology, endoscopy had been an important and low-invasive tool to diagnose and treat upper gastrointestinal diseases. Owing to discomfort of patients, it has obstacle for patients to undergo. It is an important issue not only to decrease the discomfort of patients but also keep the quality of diagnosis. There were many useful methods to be speculated, including sedated endoscopy, capsule endoscopy, virtual endoscopy and ultrathin endoscopy. Compared with conventional sedated peroral upper gastrointestinal endoscopy, unsedated transnasal endscopy has similar overall satisfaction, shorter recovery duration, more rapid for patients to return work and lower cost. Compared with unsedated peroral ultrathin upper gastrointestinal endoscopy, unsedated transnasal ultrathin endoscopy had more patient tolerance, less sympathetic stimulation and more patients’ willing to undergo next exam by similar method. Laryngologists usually perform laryngoscopy for patients in sitting position. During the procedure, patients watch the monitor, understand what physicians do and may have more satisfaction. Thus, the study compared the satisfaction of patients underwent unsedated transnasal ultrathin uppergastrointestinal endoscopy in sitting position with conventional left decubitus position. Method and Material: Patients were enrolled from outpatient clinic of gastrointestinal department in a teaching hospital in Taichung. Enrolled criteria included age between 18 and 70, first endoscopy and suffered from epigastralgia or acid regurgitation…etc. They were divided into two groups randomly. One was unsedated transnasal upper gastrointestinal endoscopy performed in sitting position. The other in left decubitus position. Primary outcome was patients’ satisfaction. Secondary outcome was procedure duration. Results : Between Oct. 20008 and Mar. 2009, 85 patients were enrolled. 43 patients were randomly divided into sitting group. 42 patient left decubitus group. There was no significant difference in demographic data, indications and results of exam. The visual analog score of sitting group was 3.11±2.69 and left decubitus group was 2.59±2.54（ p=.371）. Duration of procedure of sitting group was 276±107seconds and left decubitus group was 184±49 seconds（p=.000）.When patients who received rapid urease test or biopsy were excluded, duration of procedure were 245±63 and 179±57seconds（p=.002）respectively. Conclusion: The study revealed that diagnostic unsedated transnasal upper gastrointestinal endoscopy performed in sitting position had similar patients’ satisfaction compared with performed in convention left decubitus position but needed more time.