評估接受非麻醉下大腸鏡的病人meperidine的止痛效果

Analgesic effect of meperidine in patients undergoing unsedated colonoscopy

蔡明璋(Ming-Chang Tsai)

指導教授 ： 林俊哲

中山醫學大學/醫學院/醫學研究所/碩士(2010年)

https://doi.org/10.6834/CSMU.2010.00145

摘要

根據衛生署國民健康局的統計，十大癌症死因中大腸直腸癌高居第三名，目前已有多種篩檢大腸癌的方式（如糞便潛血反應、乙狀結腸鏡、下消化道鋇劑攝影、大腸鏡或電腦斷層虛擬大腸鏡等），其中大腸鏡檢查更是診斷大腸病變的重要工具。但由於大腸鏡檢查時常造成病人腹脹及腹部疼痛，這些檢查中的不適會提高醫師在進行大腸鏡的難度，大部分的病人會在檢查前接受適度的止痛藥物（如meperidine）來減少大腸鏡檢查帶來的疼痛，不過這類的藥物有時會造成一些不良反應（如頭暈、嘔吐等），因此投予這類藥物對大腸鏡檢查的幫助仍有待釐清。本研究的目的在針對接受非麻醉下大腸鏡檢查（unsedated colonoscopy）的病人，評估meperidine的止痛效果。在中部某醫學中心，採取前瞻性方式納入217名接受非麻醉大腸鏡的患者，比較鏡檢前接受25毫克meperidine肌肉注射與否，分析兩組病患大腸鏡檢查到達盲腸的成功率（cecum reaching rate）、所需時間（insertion time）以及使用視覺類比量表（visual analog scale, VAS）評估腹部疼痛的嚴重度。結果發現兩組病人大腸鏡的成功率均超過99%、接受meperidine肌肉注射的病人其到達盲腸時間為7.14±5.45分鐘，未接受的一組為6.24±4.24分鐘（P=0.309），平均疼痛分數分別為3.54±3.13及2.46±2.75（P=0.009），在接受meperidine的病人中，男性比例較低（40.3% vs. 55.7%, P=0.034），此外，兩組病患對此檢查的接受度也都超過九成。結論：本研究指出，兩組患者在接受非麻醉大腸鏡時都未感明顯不適，且均有相當高的接受度，檢查前投予meperidine並不會減少病人的疼痛，兩組病人到達盲腸的成功率及所需時間無明顯差異，因此，當病患在有經驗的內視鏡醫師檢查下，檢查前投予meperidine來止痛並不是必要的處置。

關鍵字

大腸鏡檢查 ； 止痛 ； meperidine

並列摘要

Introduction: Colonoscopy is a standard and useful examination in diagnosis of colorectal disease. But it usually caused painful experience to patients. Those unpleasant effects always made the procedure more difficult. Therefore, most patients received several narcotics, eg. meperidine, for relief of pain during unsedated colonoscopy. Whether administration of sedatives or narcotics to patients will facilitate the performance of colonoscopy or reduce pain need to be elucidated.
Purpose: To evaluate the analgesic effect of meperidine as premedication for patients underwent unsedated colonoscopy
Method: From July to September 2009, 217 patients (109 men, 108 women) received diagnostic unsedated colonoscopy with one-person & short-axis method by three experienced endoscopists in a medical center. Group A, included 77 patients (mean age 51.6), received 25mg meperidine intramuscularly before colonoscopy. Group B, included 140 patients (mean age 50.7), received no analgesics. Cecum reaching rate, insertion time, and questionnaires to evaluate colonoscopy-related abdominal pain were recorded and analyzed. Pain was graded by visual analog score (VAS) from score 0 to 10.
Result: The cecum reaching rate was more than 99 % in both groups. The mean insertion time was 7.14±5.45 minutes in group A and 6.24±4.24 minutes in group B (P=0.309). Pain score was 3.54±3.13 in group A and 2.46±2.75 in group B (P=0.009). The majority of patients in both groups didn’t feel uncomfortable during the whole examination even without sedation, and more than 95 percent of patients agreed that sedation is not mandatory in next colonoscopic examination if needed.
Conclusion: In our study, premedication with meperidine did not make patients fell less abdominal pain during unsedated colonoscopy. The total insertion time and cecum reaching rate showed no significant difference between patients with or without meperidine. Premedication with intramuscular meperidine are not absolutely mandatory while performing unsedated colonoscopy under skillful maneuver.

並列關鍵字

Colonoscopy ； analgesia ； meperidine

參考文獻

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