温水或二氧化碳气体在困难结肠镜检查中的应用效果比较

Comparison of the application effect of Warm-water or Carbon Dioxide Insufflation in difficult colonoscopy

目的对比注温水或二氧化碳(CO_(2))气体在困难结肠镜检查中的安全性和临床价值。方法选取2021年5月-2023年10月于该院门诊行非麻醉困难结肠镜检查的患者150例,随机分为注温水组(W组,n=50)、注CO_(2)气体组(C组,n=50)和注空气组(A组,n=50)。比较3组患者进镜时间、检查中及结束后20 min、结束后1 h腹痛视觉模拟评分法(VAS)、插管成功率、息肉检出率、再检查意愿率和操作过程中是否需外界辅助等。另外随机选取A组和C组部分患者,比较检查前、达回盲部和检查后20 min呼气末二氧化碳分压(PetCO_(2)),以了解体内CO_(2)潴留情况。结果A组检查进镜时间长于W组和C组,且W组短于C组;A组各时间点腹痛VAS高于W组和C组,且W组检查中腹痛VAS低于C组;A组插管成功率和再检查意愿率低于W组和C组,差异均有统计学意义(P<0.05),W组和C组检查结束后20 min和1 h腹痛VAS、插管成功率和再检查意愿率比较,差异均无统计学意义(P>0.05)。W组需要助手腹部按压率明显低于A组和C组,转换体位率明显低于A组,差异有统计学意义(P<0.05)。3组患者息肉检出率比较,差异无统计学意义(P>0.05)。C组各时点的PetCO_(2)均在正常范围内,与A组比较,差异无统计学意义(P>0.05)。结论与注空气法相比,注水或CO_(2)气体在困难结肠镜检查中成功率高,安全性好,可减轻患者腹部不适感,特别是注水肠镜更适合在基层医院推广。

Objective To compare the safety and clinical value of warm-water infusion or carbon dioxide(CO_(2))insufflation in difficult colonoscopy.Methods A collection of 150 patients from May 2021 to October 2023 who underwent unsedated and difficult colonoscopy were randomly divided into warm-water insufflation group(W group,n=50),CO_(2)insufflation group(C group,n=50)and air insufflation group(A group,n=50).Record the cecal insertion time,the abdominal pain score during the examination and 20 min and 1 h after the examination,the success rate of intubation,the polyps detection rate,the willingness to re-examine and the need for assistance in the three groups.Some patients were randomly selected to record partial pressure of end-tidal carbon dioxide(PetCO_(2))of pre-examination,the ileocecal and 20 min after the examination to understand CO_(2)retention in the body.Results The cecal insertion time of group A was longer than that of group W and group C,and group W was shorter than group C.The abdominal pain score of group A was higher than that of group W and group C at each time point,and the abdominal pain score during the examination was lower in the group W compared with group C.The success rate of intubation and the willingness to re-examination in the group A were lower than those in group W and group C,The above differences were statistically significant(P<0.05).However,there was no statistical difference between the the group W and group C in terms of success rate of intubation,willingness to re-examine,and abdominal pain score at 20 minutes and 1 hour after the examination(P>0.05).In the group W,significantly fewer patients required abdominal compression compared with the other two groups,and the rate of position conversion was significantly lower than that in group A(P<0.05).There was no significant difference in the detection rate of polyps among the three groups(P>0.05).In addition,PetCO_(2)of group C was within the normal range at all time points,and there was no statistical difference compared with the group A(P>0.05).Conclusion Compared with the air group,water or CO_(2)insufflation colonoscopy is safe and has a high success rate in difficult colonoscopy.It can reduce the patient’s abdominal discomfort,especially water insufflation colonoscopy is more suitable for promotion in primary hospitals.