Riss Stefan, Akan Belgin, Mikola Barbara, Rieder Erwin, Karner-Hanusch Judith, Dirlea Dragos, Mittlböck Martina, Weiser Friedrich Anton
Department of Surgery, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2009;121(13-14):464-8. doi: 10.1007/s00508-009-1202-y.
Air insufflation during colonoscopy is considered the standard method in most endoscopic centers. Notably, several studies have reported reduced abdominal pain after colonoscopy with CO2 insufflation in unsedated and in lightly sedated patients. The present study was designed to assess the efficacy of CO2 insufflation after colonoscopy in moderately and deeply sedated patients. We also evaluated whether CO2 insufflation increases patients' compliance for colorectal cancer screening.
A total of 300 consecutive patients allocated to colonoscopy were randomly assigned to either CO2 or air insufflation. Propofol was titrated to a level of deep sedation and propofol combined with midazolam was used for moderate sedation. Post-interventional pain levels and satisfaction with the procedure were registered on a 10-point visual analog scale. Compliance for colorectal cancer screening was ascertained separately.
CO2 insufflation was used during colonoscopy in 157 patients; conventional air was used in 143 patients. The two groups were comparable with regard to age, sex and body mass index. Neither major nor minor complications were observed. Pain sensation was significantly lower in the CO2 group at 15 min, 30 min and 6 h after colonoscopy (P<0.01); at 12 h no difference was observed. In contrast, levels of patient satisfaction did not show any significant difference. Voluntary colorectal cancer screening appeared not to be influenced by the type of insufflation gas used.
CO2 insufflation in deeply and moderately sedated patients during colonoscopy has no impact on patients' satisfaction with the procedure or on their attitude to voluntary colorectal cancer screening. However, the use of CO2 insufflation significantly diminishes abdominal pain after colonoscopy.
在大多数内镜中心，结肠镜检查期间的空气注入被视为标准方法。值得注意的是，多项研究报告称，在未镇静和轻度镇静的患者中，二氧化碳注入的结肠镜检查后腹痛减轻。本研究旨在评估二氧化碳注入在中度和深度镇静患者结肠镜检查后的效果。我们还评估了二氧化碳注入是否会提高患者对结直肠癌筛查的依从性。
共有300例连续接受结肠镜检查的患者被随机分配接受二氧化碳或空气注入。丙泊酚滴定至深度镇静水平，丙泊酚联合咪达唑仑用于中度镇静。干预后的疼痛水平和对该操作的满意度采用10分视觉模拟量表进行记录。分别确定结直肠癌筛查的依从性。
157例患者在结肠镜检查期间使用了二氧化碳注入；143例患者使用了传统空气。两组在年龄、性别和体重指数方面具有可比性。未观察到严重或轻微并发症。二氧化碳组在结肠镜检查后15分钟、30分钟和6小时的疼痛感觉明显较低（P<0.01）；12小时时未观察到差异。相比之下，患者满意度水平未显示任何显著差异。自愿性结直肠癌筛查似乎不受所用注入气体类型的影响。
在深度和中度镇静患者的结肠镜检查期间使用二氧化碳注入对患者对该操作的满意度或他们对自愿性结直肠癌筛查的态度没有影响。然而，使用二氧化碳注入可显著减轻结肠镜检查后的腹痛。
