注入CO2对结肠镜内镜下黏膜切除术和内镜下黏膜剥离术患者腹痛VAS评分的影响

Effects of CO2 injection on VAS score of abdominal pain in patients undergoing colonoscopic mucosal resection and endoscopic mucosal dissection

目的探讨结肠镜内镜下黏膜切除术(EMR)和内镜下黏膜剥离术(ESD)手术中选择CO2为注入气体对手术结果的影响。方法采用前瞻性研究方法,选取2018年8月至2019年10月在沈阳市肛肠医院选择EMR或ESD手术治疗的患者88例,随机数字表法平均分为2组,研究组44例患者选择术中注入CO2,对照组44例注入空气。对比2组患者的腹痛视觉模拟评分(VAS)、术后排气,以及手术前后的呼气末二氧化碳分压(PETCO2)、平均动脉压(MAP)、呼吸频率(R)、心率(HR)等生命体征指标。结果2组患者在手术过程中的腹痛评分VAS相比,差异无统计学意义(P>0.05),研究组术后即刻、术后1 h、6 h、24 h的腹痛VAS评分分别为(23.97±5.33)、(10.08±6.44)、(2.13±1.45)、(0.43±0.16)分,均明显低于对照组的(33.24±5.47)、(23.78±6.29)、(8.25±5.47)、(1.34±2.05)分,差异有统计学意义(P<0.05)。研究组术后1 h、术后6 h排气相比对照组明显减少(P<0.05);术后24 h排气与对照组相比差异无统计学意义(P>0.05)。2组患者术前PETCO2、MAP、R、HR相比差异均无统计学意义(P>0.05);研究组术后ETCO2与术前以及对照组相比差异无统计学意义(P>0.05),相比术前明显升高(P<0.05),与对照组PETCO2、MAP、R、HR相比差异均无统计学意义(P>0.05)。结论在EMR与ESD手术中注入CO2代替空气,能够有效缓解患者疼痛,改善术后排气状况,同时能够稳定呼吸、血压、心率,对机体无明显不良影响,具有较高的有效性与安全性。

Objective To investigate the effect of CO2 injection on surgical results of colonoscopic mucosal resection(EMR)and endoscopic mucosal dissection(ESD).Methods Choose between August 2018 and October 2019 in Shenyang Anorectal Hospital to choose EMR or ESD surgical treatment of 88 cases of patients,randomly divided into two groups,group 44 patients choose intraoperative injection of CO2,44 cases were injected into the air,compared two groups of patients with abdominal pain visual analogue scale(VAS),postoperative exhaust,and breathing before and after surgery at the end of the CO2 partial pressure(PETCO2),mean arterial pressure(MAP),respiratory frequency(R),the index of vital signs such as heart rate(HR).Results In the process of surgery,abdominal pain VAS score does not exist significant difference beteen the two groups of patients(P>0.05),the team immediately after operation,postoperative 1 hours,6 hours,24 hours of VAS pain score(23.97±5.33),(10.08±6.44),(2.13±1.45),(0.43±0.16)points respectively,were significantly lower than the control group(33.24±5.47),(23.78±6.29),(8.25±5.47),(1.34±2.05)points,statistically significant difference(P<0.05).Exhaust gas in the study group was significantly reduced at 1 hour and 6 hours after operation compared with the control group(P<0.05);exhaust gas at 24 hours after operation was not significantly different from the control group(P>0.05).There was no significant difference in preoperative PETCO2,MAP,R and HR between the two groups(P>0.05).There was no significant difference in preoperative PETCO2,MAP,R,and HR between the two groups(P>0.05);the postoperative ETCO2 in the study group was not significantly different from that before the operation and the control group(P>0.05),which was significantly higher than that before the operation(P<0.05).There were no significant differences in PETCO2,MAP,R,HR between the study group and the control group(P>0.05).Conclusion The injection of CO2 to replace air in EMR and ESD surgery can effectively relieve the patient's pain,improve the postoperative exhaust status,and stabilize the breathing,blood pressure and heart rate,with no obvious adverse effects on the body,thus having high efficacy and safety.