温水灌肠与注气法在非镇静结肠镜检查中的比较：一项随机对照试验。

Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial.

机构信息

Division of Gastroenterology, Valduce Hospital, Como, Italy.

出版信息

Gastrointest Endosc. 2010 Oct;72(4):701-9. doi: 10.1016/j.gie.2010.06.025.

DOI:10.1016/j.gie.2010.06.025

PMID:20883846

Abstract

BACKGROUND

Uncontrolled data suggest that warm water infusion (WWI) instead of air insufflation (AI) during the insertion phase of unsedated colonoscopy improves patient tolerance and satisfaction.

OBJECTIVE

We tested the hypothesis that water could increase the proportion of patients able to complete unsedated colonoscopy and improve patient tolerance compared with the conventional procedure.

DESIGN

Randomized, controlled trial.

SETTING

Single center, community hospital.

PATIENTS

Consecutive outpatients agreeing to start colonoscopy without premedication.

METHODS

Patients were randomly assigned to either WWI or AI insertion phase of colonoscopy. Sedation and/or analgesia were administered on patient request if significant pain or discomfort occurred.

MAIN OUTCOME MEASUREMENTS

Percentage of patients requiring sedation/analgesia. Pain and tolerance scores were assessed at discharge by using a 100-mm visual analog scale.

RESULTS

A total of 230 subjects (116 in the WWI group and 114 in the AI group) were enrolled. Intention-to-treat analysis showed that the proportion of patients requesting sedation/analgesia during the procedure (main outcome measurement) was 12.9% in the WWI group and 21.9% in AI group (P = .07). Cecal intubation rates were 94% in the WWI group and 95.6% in the AI group (P = .57). Median (interquartile range) scores for pain were 28 (12-44) and 39 (14-54) in WWI and AI groups, respectively (P = .05); corresponding figures for tolerance were 10 (3-18) and 14 (5-42), respectively (P = .01). The adenoma detection rates were 25% and 40.1% for the WWI and AI groups, respectively (P = .013).

LIMITATIONS

Single-center study, endoscopists not blinded to randomization.

CONCLUSIONS

WWI instead of AI is not associated with a statistically significant decrease in the number of patients requiring on-demand sedation, although it significantly improves the overall patient tolerance of colonoscopy. The finding of a lower adenoma detection rate in the WWI group calls for further evaluations. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT00905554).

摘要

背景

未经控制的数据表明，在未镇静结肠镜检查的插入阶段，温水输注（WWI）代替空气灌输（AI）可提高患者的耐受性和满意度。

目的

我们检验了这样一个假设，即与常规程序相比，水可以增加能够完成无镇静结肠镜检查的患者比例，并提高患者的耐受性。

设计

随机对照试验。

设置

单中心，社区医院。

患者

同意在不进行预用药的情况下开始结肠镜检查的连续门诊患者。

方法

患者被随机分配到 WWI 或 AI 插入阶段的结肠镜检查。如果出现明显的疼痛或不适，根据患者的要求给予镇静和/或镇痛。

主要观察指标

需要镇静/镇痛的患者比例。通过使用 100 毫米视觉模拟量表在出院时评估疼痛和耐受性评分。

结果

共纳入 230 例患者（WWI 组 116 例，AI 组 114 例）。意向治疗分析显示，在手术过程中（主要观察指标）要求使用镇静/镇痛的患者比例为 WWI 组 12.9%，AI 组 21.9%（P=0.07）。WWI 组的盲肠插管率为 94%，AI 组为 95.6%（P=0.57）。WWI 和 AI 组的疼痛中位数（四分位距）评分分别为 28（12-44）和 39（14-54）（P=0.05）；相应的耐受评分分别为 10（3-18）和 14（5-42）（P=0.01）。WWI 和 AI 组的腺瘤检出率分别为 25%和 40.1%（P=0.013）。