肥胖患者行无痛苦结肠镜检查的安全性评价

Safety Evaluation of Painless Colonscopy in Obese Patients

目的探讨肥胖患者在行无痛苦结肠镜检查的安全性。方法纳入292例接受肠镜检查的患者,根据体重指数(BMI)和检查方式(普通肠镜检查简称普通,无痛肠镜检查简称无痛),分为肥胖普通检查组(G1)、肥胖无痛检查组(G2)、正常普通检查组(G3)及正常无痛检查组(G4)。观察并记录4组患者肠镜检查过程中在麻醉前或准备进境前(t1)、达到回盲部时(t2)及检查结束患者清醒时(t3)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(oxyhemoglobin saturation,SpO2)变化及是否发生腹胀、腹痛、恶心、呕吐、头晕、心动过缓、肢体扭动等不良反应。结果无痛组行结肠镜检查时t2时刻的MAP、HR较t1时显著下降(P<0.05),其中G2组在t2时刻的SPO2较t1时下降显著(P<0.05),普通组行结肠镜检查时t2及t3时刻的MAP、HR、SPO2较t1时相比,差异无显著性(P>0.05),普通组检查期间的不良反应发生率较高(P<0.001),普通组到达回盲部时间较无痛组明显延长(P<0.05),而在完成总时间上无明显差异(P>0.05)。G3组结肠镜检查成功率显著高于G1组(P<0.05)。结论肥胖患者行无痛结肠镜检查不仅可减轻痛苦提高依从性,且安全性较高。

Objective To investigate the safety of obese patients undergoing painless colonoscopy. Methods 292 patients were divided into obese common group(G1), obese painless group(G2), normal group(G3) and normal painless group(G4). Changes in mean arteria pressure(MAP), heart rate(HR), blood saturation(SPO2) as well as intraoperative and postoperative adverse reactions of the patients such as abdominal distension, abdominal pain, nausea, oomit, dizzy, bradycardia, limb writhing, were observed and recorded in the 4 group before the colonoscopy(t1), when they reached the ileocecal stage(t2), and after the examination(t3). Results During colonoscopy examination, the MAP and HR in patients undergoing painless colonoscopy at t2 were significantly lower than those at t1(P<0.05), the SPO2 in obese patients at t2 decreased significantly than that at time t1. There was no significant difference in MAP, HR, SpO2 at t2 and t3 time in patients undergoing common colonoscopy compared with t1 time(P>0.05).About adverse reaction, the incidence rate of abdominal distension and nausea in ordinary enteroscopy was higher than painless enteroscopy(P<0.05). The time to reach the ileocecum in the painless colonoscopy group was significantly shorter than that in the common enteroscopy group(P<0.05), and there was no significant difference in total time(P>0.05). The success rate of G3 enteroscopy was significantly higher than that of G1(P<0.05). Conclusion It is feasible to carry out painless colonoscopy in obese patients,which can not only relieve the pain of obese patients, but also improve compliance and the safety.