Investigation of anxiety, pain/discomfort, cardiovascular responses and physiologic reactions in patients undergoing gastrointestinal endoscopy

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程槛董
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2 Investigation of anxiety, pain/discomfort, cardiovascular responses and physiologic reactions in patients undergoing gastrointestinal endoscopy

3 Abstract

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4 31% 74% [33] Jones MP [34] 94 - State-Trait Anxiety Inventory STAI State Anxiety Trait Anxiety DiSario JA [95] % MAP<60 mmhg 6% MAP>130 mmhg 30% HR<60 bpm 26% (HR>100 bpm 32%) [96] [97] / 1

DiSario JA [95] 618 71% MAP<60 mmhg 6% MAP>130

5 2

6 1527 SAS P< P=0.026 P<0.01 P<0.05 P<0.01 P<0.01, P<0.01, P<0.01 P<0.01, P< % 41.8% 50.1% 20% 12.0% 18.3% 88.4% 41.1% 71.6% 3

7 57.1% 4

8 Abstract Abstract Investigation of anxiety, pain/discomfort, cardiovascular responses and physiologic reactions in patients undergoing gastrointestinal endoscopy Master Degree Candidate Xue Li Mentor Associate Professor Yi Feng Objective To investigate the prevalence of anxiety, pain/discomfort, cardiovascular responses and physiologic reactions in patients undergoing gastrointestinal GI endoscopy. Methods Consecutive 1527 patients referred for gastroscopy or colonscopy without sedation or supplemental oxygen therapy were evaluated and monitored. Anxiety level was assessed prior to examination with Self-rating Anxiety Scale(SAS). Self-rated pain/discomfort scores were rated after the procedure by using visual analogue scale (VAS). Hemodynamic parameters were recorded at 2-min intervals before, during, and after the procedure. Patients were grouped by sex, age, education background, previous experience, anxiety level, baseline mean blood pressure (MBP) and heart rate (HR), coexisting diseases, intensities of pain/discomfort during the procedure, endoscopists experiences, and the type of endoscopic procedure. Risk factors associated with anxiety level, pain/discomfort and cardiovascular responses were identified. Results The mean SAS score of all patients was 31.50±8.47, higher than which of normal population (29.78±10.07). Higher anxiety levels were found in females and patients with high school education background (P<0.001). The intensities of pain/discomfort in patients undergoing colonoscopy were higher than those undergoing gastroscopy (P<0.01, P<0.01). Regression analyses showed that young age, females, anxiety, colonoscopy and endoscopists experiences were predictors of pain and/or discomfort during the procedure. The GI endoscopies induced different cardiovascular responses during the 5

endoscopy. Methods Consecutive 1527 patients referred for gastroscopy or colonscopy without sedation or supplemental oxygen therapy were evaluated and monitored.

9 Abstract procedure, which returned to normal after the examination. Gastroscopy resulted in a significantly increased MBP and HR, while colonoscopy caused a decreased MBP and HR. The risk factors associated with cardiovascular responses during gastroscopy included: female (MBP:OR=1.529, HR:OR=1.451), middle age (MBP:OR=1.399, HR:OR=1.928), discomfort during insertion (MBP:OR=1.548, HR:OR=1.542)/ examination (MBP:OR=1.373, HR:OR=1.588) and the endoscopists experiences(mbp:or=1.905, HR:OR=1.856); The risk factors correlated with cardiovascular responses during colonoscopy included: female(mbp: OR=2.148, HR: HR:OR=2.059), pain during insertion (MBP:OR=2.664, HR:OR=1.866)/examination (MBP:OR=1.953, HR:OR=2.051) and discomfort during insertion (MBP:OR=1.875, HR:OR=1.987). Patients underwent gastroscopy experienced more nausea, vomiting and tearing (88.4%, 41.1% and 71.6%, respectively), while patients underwent colonoscopy experienced more groan (57.1%). Conclusions Patients waiting for GI endoscopy experience mild to moderate levels of anxiety. The pain/discomfort and cardiovascular responses during gastroscopy are different from colonoscopy. This finding is highly significant to clinicians, who can provide individualized intervention for patients. Key words: Epidemiology; Gastrointestinal endoscopy; Anxiety; Pain; Cardiovascular responses 6

928), discomfort during insertion (MBP:OR=1.548, HR:OR=1.542)/ examination (MBP:OR=1.373, HR:OR=1.588) and the endoscopists experiences(mbp:or=1.905, HR:OR=1.

10 % [1] Natural Killer [2-4],, ( ) 7

11 [5-7] Johnston M [8 9] 1. 1 Kimball CP [10,11] adaptative type (symbiotic type) (denial anxiety type) (depressive type) Guy Vingerhoets [12]

12 A type A behavioral pattern [13-15] Jenkins CD [16,17] 6 Wright JE [18] 3 Lanuza DM [19] 2. [20,21] Oates M Gath D [ 22] Lalinec-Michaud M [23] 102 9

13 [24] 3. dental fear and anxiety symptom of dental fear learned behavior [25] [26] 4. Lang T [27] 32.8% % 2 1/4 1 1/3 20 : Triffaux JM [28 29] 1 10

fear learned behavior 3500 1000-1200 [25]

14 6 Nickel R [30] [31] [32] 6. 31% 74% [33] Jones MP [34] 94 - State-Trait Anxiety Inventory STAI State Anxiety Trait Anxiety 7. [35] [36,37] [38] 11

15 Regel H [39] 54% [39,40] [41,42] [43] / [44] [45-47] Nomura M [48] Cosentino M [49] 32 Karanci AN [35] [47] Caumo W [50] 592 / Kureshi J [51] / Lipp M [52]

16 Ng SK [53] [54] [41 47] [55] Jenkins CD [56] Bunzel B [57] 50 Enqvist B [58] 30 13

painless gastroscopy is associated with less intraoperative and postoperative adverse reactions, and is therefore safer and more comfortable. 2015 Bai

painless gastroscopy is associated with less intraoperative and postoperative adverse reactions, and is therefore safer and more comfortable. 2015 Bai : http://www.baishideng.com/wcjd/ch/index.aspx : http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.11569/wcjd.v23.i5.788 2015218; 23(5): 788-792 ISSN 1009-3079 (print) ISSN 2219-2859 (online) 2015. CLINICAL