非鎮靜麻醉下診斷性胃鏡病患就檢接受度、難受度、與就檢滿意度之研究

The study on patient’s acceptance, tolerance and satisfaction of unsedated diagnostic esophagogastroscopy

林連豐(Lian-Feng Lin)

指導教授 ： 馬可容

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00029

摘要

研究目的
1．探討病患之人口學特徵，個人屬性、及病患對胃鏡檢查的認知、接受過
胃鏡檢的經驗與檢查前的焦慮程度在胃鏡檢查的難受度、與就檢満意度
之差異。
2．探討胃鏡管徑大小與胃鏡檢查的途徑(經口檢查與經鼻檢查)在病患胃鏡
檢查的難受度、再次接受相同檢查的意願與就檢満意度之差異。
3．探討病患之人口學特徵，及病患對胃鏡檢查的認知、接受過胃鏡檢的經
驗與檢查前焦慮程度，胃鏡管徑大小與胃鏡檢查的途徑對胃鏡檢查的難
受度、與就檢満意度之影響。
4． 探討經鼻胃鏡檢查與經口胃鏡檢查所花費之時間耗用之差異，建立實證
資料支持經鼻胃鏡檢查增收費用之合理性。探討細管胃鏡口經檢查與經
鼻檢查之臨床結果之差異，是否能取代經鼻檢查以省去鼻腔麻醉時間與
鼻腔插管之不適與併發症。
研究方法
本研究採隨機分配實驗設計，328 位門診或體檢病患需做胃鏡檢查者
依看病順序隨機分成三組，分別施與標準胃鏡管徑9mm 經口檢查，細管徑5mm
經口檢查和細管徑5mm 經鼻檢查。為控制干擾變項，在單一胃鏡室由同一批護理
技術員執行檢查前之準備，由同一位醫師執行檢查操作，檢查時段安排在9-11
am，以控制操作者與時段之變項。檢查前先予問卷訪問人口特徵如性別、年齡、
教育程度、胖肥、家庭收入…以及個自覺健康狀態、健康信念、個人胃病史、家
族胃病史、過去病史、對胃鏡檢查的認知、接受過胃鏡檢的經驗、與檢查前的焦
慮程度。檢查中計錄心跳，血氧，嘔吐及嗆到之次數。以及第三者觀察之不適程
度。和檢查所花費時間，檢查完成後問卷訪問檢查過程鼻或咽麻醉，插管，檢
VII
查中，和拔管後之難受程度。 以 VAS 0—10 分之量表(0 代表無難過，10 代表
無法忍受)測量其檢查難受的程度。同時問卷訪問這次就檢之滿意度以五等級量
表，(參考Rubin 之PPS ) 以及下次接受同樣檢查之意願。
研究結果
本研究共收入 328 位病患同意加入研究，110 位患者隨機編入5mm 胃鏡經
鼻檢查這組，5 位因故未到檢而被退出研究(withdrawer)，105 位接受經鼻胃鏡檢
查，其中6 位因鼻腔狹窄無法插管檢查(失敗率5.7%)，99 位成功完成檢查(成功
率94.3%)、2 位發生鼻腔出血。109 位患者隨機編入5mm 胃鏡經口檢查這組，6
位因故未到檢而被退出研究(withdrawer)，103 位接受並成功完成5mm 胃鏡經口
檢查。109 位患者隨機編入9mm 胃鏡經口檢查這組，5 位因故未到檢而被退出研
究(withdrawer)，104 位接受並成功完成9mm 胃鏡經口檢查。306 位完成檢查受
試者都在胃鏡室完成問卷回答。
本研究發現影響胃鏡檢查滿意度之變項有年齡、檢查的難受程度、婚姻、家
庭年收入、胃鏡管徑大小、與檢查能改善胃疾的信念；而會影響胃鏡檢查難受性
的變項有年齡、性別、婚姻狀況、胃鏡管徑大小與檢查途徑。影響接受度的變項
有胃鏡管徑大小與檢查的難受程度。下次願意接受5mm胃鏡檢查的意願為9mm胃鏡
的4.6倍；影響胃鏡檢查滿意度的因素之預測力依序為胃鏡管徑大小、家庭年收
入、認知(R平方 0.11)，加入胃鏡檢查難受度後，R平方提升到0.43，但管徑大
小被排擠掉；預測胃鏡檢查難受的因素依次為年齡、胃鏡管徑大小、性別 (R平
方0.225)。經鼻胃鏡檢查明顯耗費較長時間，5mm胃鏡口檢查與經鼻胃鏡檢查有
相當的難受度、接受度與滿意度，加上較省時、沒有插管失敗與鼻出血的缺點，
5mm胃境經口檢查優於經鼻檢查是理所當然的結論。
結論與建議
結論一．預測胃鏡檢查滿意度較佳的病患因素為：胃鏡檢查的認知、高家庭年入、
年長、已婚、具檢查能改善胃疾的信念。預測胃鏡檢查難受度較低的病
患因素為：年長、男性、已婚。。
VIII
二．經鼻檢查的途徑不影響檢查的滿意度，也不影響檢查的難受度。
三．細管徑 5mm 的胃鏡管子是影響滿意度、接受度與耐受度得最佳預
測因子。
四．5mm 胃鏡經鼻檢查耗時，應酌收合理部分費用。
5mm 胃鏡經口檢查優於5mm 胃境鏡經鼻檢查，耗時短、成功率高、無
鼻出血之併發症。
建議一．未曾有過胃鏡經驗的年輕、未婚、女性病患，建議細管胃鏡檢查。
二．標準胃鏡耐受性差的患者，建議難受度低的細管徑胃鏡經鼻或經口檢查。
三．可推廣細管經鼻胃鏡檢查並增收費用500 元，細管徑胃鏡經口檢查可取
代經鼻檢查。

關鍵字

非鎮靜麻醉診斷性胃鏡 ； 經鼻胃鏡 ； 細管胃鏡

並列摘要

Aims:
1. To explore the difference of patient’s tolerance and satisfaction of unsedated
diagnostic esophagogastroscopy(UD-EGD) between patient’s characteristics.
2. To explore the difference of patient’s acceptance, tolerance and satisfaction of
UD-EGD between different scope size and scoping route ( transnasal or
Peroral? )
3. To determine the effect of these factors on the outcomes of acceptance,
tolerance and satisfaction.
4. To explore the difference of scoping time between transnal EGD and peroal
EGD . And to determine whether peroral ultra-thin EGD is superior to
transnasal ultra-thin EGD？
Materials and methods
328 OPD patients were enrolled and were allocated randomly to three groups to
undergo EGD with different scope size and scoping route —110 patients for 5mm
transnasal(TN) , 109 patients for 5mm-peroral(PO), and 109 patients for 9mm
standard EGD(ST). This study was proved by IRB of Ping-Tung Christian Hospital
and all the patient’s age, sex, marriage, income , education , BMI , experience of
EGD , history of GI disease , family GI disease history, chronic disease history, the
knowledge of EGD, anxiety before EGD were collected before procedure . During
the procedure, the heart rate and PaO2 , the frequence of gagging and choking, and
the procedure time were recorded by the nurse . After completing the EGD
procedure, patients were asked to answer the validated questionnaires which included
three outcomes—acceptability, tolerance and satisfaction. Acceptabilty was defined as
the willing to choose the same procedure in the future. Tolerance was defined as
discomfort which is measured by validated VAS scale 0-10 ( 0 means no discomfort,
10 means untolerable discomfort) during topical anesthesia, intubation, examination,
extubation and overall. Satisfaction questionnaire, modified from Robbin PPS,was
designed regarding to the EGD procedure, dorctor’s skill, waiting time and procedure
time, physician’s explaining , and nurse’s attitude .
X
Result
Five patients withdrawed form the TN group and 105 underwent the transnasal
EGD. There were 6 failures of nasal intubation due to anatomic problem and 99
patients completed the procedure. Two of the 99 patients developed nasal bleeding.
Six patients and five patients withdrawed from the PO group and ST group repectively.
All of the remainders of PO group and ST group complete EGD successfully without
adverse event. Statically significant factors for satisfaction are old age, low
discomfort VAS scores, married, high income, small scope size and positive belief .
Significant factors for tolerance are old age, small scope size, male gender and
married. Scope size rather than scoping route is the determining factor for
acceptability , tolerance and satisfaction. The procedure time of transnasal EGD is
longer than that of peroral EGD. Compared to ultra-thin 5 mm peroral EGD, the
trans-nasal route need longer time 19.9 minutes vs 16.8 minutes, induced less gagging
reflux 1.7 vs 2.8 times , sense more pain during intubation 2.8 vs 1.56 VAS scores, the
insignificant different willing to do the same procedure in the future is 87.9% vs
94.2%. There is no significant difference of procedure discomfort and satisfaction
between the transnasal route and peroral route ( 13.2 vs 13.1 VAS scales, and 49.2 vs
49.1 score ).
Conclusion
1. The significant factor of satisfaction is small scope size, knowledge of EGD and
income. The significant factor of procedure discomfort is old age , small scope
size and male gender.
2. Small scope size rather than scoping route is the determining factor of
acceptability, discomfort and satisfaction.
3. The procedure time of trans-nasal EGD is longer than per-oral EGD
4. Peroral ultra-thin EGD is superior to transnasal ultra-thin EGD owing to good
acceptability , low discomfort, high satisfaction , high successful rate and no
bleeding complication.

並列關鍵字

Unsedated EGD ； transnasal EGD ； Ultra-thin EGD

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