二氧化碳灌注提高老年患者结肠镜检查舒适度的随机对照研究

Insufflation of Carbon Dioxide at Colonoscopy Elevates Degree of Comfort in Elderly Patients:A Randomized Controlled Trial

背景:常规空气灌注式结肠镜检查往往会造成不同程度的腹痛、腹胀等不适,探求更好的结肠镜检查方式具有重要临床意义。目的:评价二氧化碳(CO2)灌注用于老年患者结肠镜检查的舒适度和安全性。方法:98例老年患者随机分为4组,各组基线情况基本一致,分别以空气或CO2为注气媒介,辅以或不辅以镇痛药行结肠镜检查。以直观模拟量表(VAS)评价检查中和检查后5、10、15、20 min腹痛、腹胀情况。每组分别随机选取8例患者,8例于检查后10 min行动脉血气分析,另8例于检查后60 min拍摄腹部X线平片评价肠管扩张程度。结果:CO2组和CO2+镇痛组各时点腹痛、腹胀VAS评分以及检查后肠管扩张程度评分分别显著低于空气组和空气+镇痛组(P<0.01),CO2+镇痛组检查中腹痛、腹胀VAS评分显著低于CO2组(P<0.05)。四组间各项结肠镜操作参数以及动脉血pH值和PCO2差异无统计学意义,且均无严重并发症发生。结论:CO2灌注式结肠镜检查用于老年患者安全、有效,舒适度较空气灌注式结肠镜检查明显提高。

Background： Abdominal pain and bloating are common distressing symptoms resulting from air insufflated colonoscopy, seeking better methods for colonoscopy is of importance in clinical practice. Aims： To assess the degree of comfort and safety of carbon dioxide （ CO2 ） insufflated colonoscopy in elderly patients. Methods： A total of 98 elderly patients were randomized into four groups and underwent colonoscopy by using air or CO2 insufflation with or without analgesics, respectively. The baseline characteristics were similar in these four groups. Abdominal pain and bloating experienced by the patients during and 5, 10, 15, 20 minutes after the procedure was registered using a visual analogue scale （VAS）. Bowel distention after the procedure was evaluated by abdominal radiograph taken at 60 minutes in 8 selected patients in each group. Blood gas analysis of arterial blood was conducted 10 minutes after the procedure in another 8 selected patients. Results： VAS score of abdominal pain and bloating at different time points, as well as the score of bowel distention were significantly lower in CO2 insufflated group and CO2 insufflated ＋ analgesics group than in air insufflated group and air insufflated ＋ analgesics group, respectively （ P 〈 0.01 ）. During colonoscopic procedure, VAS score of abdominal pain and bloating was significantly lower in CO2 insufflated ＋ analgesics group than in CO2 insuffiated group （ P 〈 0.05）. Colonoscopic parameters, as well as pH and PCO2 of arterial blood were similar in these four groups. No severe complications were observed in all these elderly patients. Conclusions：CO2 insufflated colonoscopy has the same security and efficiency as air insufflated colonoscopy, yet can elevate the degree of comfort in elderly patients.