二氧化碳注入在结肠镜检查中的Meta分析

Carbon dioxide insufflation during colonoscopy:a meta-analysis

目的:评价应用二氧化碳进行结肠镜检查的安全性与有效性.方法:检索Cochrane图书馆;PubMed数据库;EMBASE数据库;重庆维普中文科技期刊数据库截止日期为2011-06,没有语言限制.所有关于结肠镜检查中应用二氧化碳注入对比空气注入的临床随机对照实验被纳入,对纳入研究的方法学进行评价,并运用统计学分析软件RevMan5.10进行Meta分析.结果:检索出9篇随机对照试验,共计2065个参与者.Meta分析结果示:(1)检查1h后无疼痛人数:共3个试验被纳入,显示二氧化碳组优于空气组,相对危险度RR=1.57;95%CI:1.35-1.82(P<0.05);(2)检查6h后无疼痛人数:共4个试验被纳入,显示二氧化碳组优于空气组,相对危险度RR=1.30,95%CI:1.17-1.45(P<0.05);(3)插管至回盲部时间:共5个试验纳入,显示两组无统计学差异,均数差MD为-0.73,95%CI:-1.73-0.27(P=0.15);(4)呼气末二氧化碳分压:仅一个试验被纳入,两组无统计学差异.结论:结肠镜检查中二氧化碳注入对比空气注入能减轻检查后疼痛,检查时间无统计学差异;未发现二氧化碳注入增加呼气末二氧化碳分压增加副作用的发生率,进一步的高质量研究需要被开展.

AIM： To assess the safety and efficacy of carbon dioxide insuffiation during colonoscopy. METHODS： We searched the Cochrane Central Library, MEDLINE, EMBASE, VIP until June 2011. No language restrictions were replied. All the RCTs comparing carbon dioxide insuffiation versus air insuffiation during colonoscopy were included. The quality of included studies was evaluated and a meta-analysis was performed using RevMan5.1.0 software. RESULTS： Nine randomized controlled trials （RCTs） encompassing a total of 2 065 patients were included. The result of meta-analysis showed that carbon dioxide insufflation was superior to air insufflation in reducing the discomfort after colonoscopy. The participants without any discomfort 1 h after the examination from three RCTs （RR, 1.57; 95% CI, 1.35 to 1.82;P 〈 0.05） and 6 h after the examination from four RCTs （RR, 1.30; 95% CI, 1.17 to 1.45; P 〈 0.05） differed significantly between the two groups. There were no statistical differences in the pooled mean difference （MD） of cecal intubation time from five RCTs （MD, -0.73; 95% CI, -1.73 to 0.27; P = 0.15） and in ET CO2 from one study between two groups. CONCLUSION： Carbon dioxide insuffiation can reduce discomfort after colonoscopy examination. Cecal intubation time was not statistically different between the carbon dioxide insuffiation group and air insuffiations group. Use of carbon dioxide did not add risk of side-effects caused by the increase of ET CO2.