Diakonissen-Stiftungs-Krankenhaus Speyer, Innere Medizin, Gastroenterologie, Gastrointestinale Onkologie, Speyer, Germany.
Endoscopy. 2012 Oct;44(10):940-51. doi: 10.1055/s-0032-1310157. Epub 2012 Sep 17.
Warm water infusion instead of traditional air insufflation during the insertion phase of colonoscopy has been proposed to reduce pain and improve patient acceptance of the procedure. This systematic review aimed to compare warm water infusion with standard air insufflation according to findings from randomized controlled trials (RCTs).
In a systematic review and meta-analysis of RCTs comparing warm water infusion with standard air insufflation, primary outcome measures were procedure-related (cecal intubation, time to cecal intubation, and adenoma detection rates) and patient-related (pain).
Nine studies (1283 patients) were included. Warm water infusion, as sole modality for facilitating insertion, was associated with a fourfold higher risk of cecal intubation failure compared with air insufflation (risk ratio [RR] 4.01, confidence interval [CI] 1.17 to 13.78, P = 0.03), but this risk did not significantly differ between warm water infusion and air insufflation with the hybrid technique (i. e., brief use of air when difficulty, e. g. poor view, was encountered). Warm water infusion and air insufflation were associated with similar cecal intubation times (P = 0.62) and adenoma detection rates (P = 0.49), but with warm water infusion patients experienced significantly less pain (P < 0.00001) and a significantly lower proportion requested sedation and/or analgesia (RR 0.48, CI 0.35 to 0.66, P < 0.00001).
Although failure of cecal intubation is more frequent with warm water infusion, technical modifications, i. e., short air insufflations, can abolish this. Warm water infusion is less painful than standard air insufflation, reduces the need for sedation/analgesia, and improves patient acceptance of colonoscopy, without additional adverse reactions.
在结肠镜检查的插入阶段，与传统的空气注入相比，温水灌注被提议用于减轻疼痛并提高患者对该程序的接受度。本系统评价旨在根据随机对照试验（RCT）的结果比较温水灌注与标准空气注入。
在一项比较温水灌注与标准空气注入的 RCT 的系统评价和荟萃分析中，主要的结局测量指标是与程序相关的（盲肠插管、到达盲肠插管的时间和腺瘤检出率）和与患者相关的（疼痛）。
纳入了 9 项研究（1283 名患者）。与空气注入相比，作为促进插入的单一方式，温水灌注与盲肠插管失败的风险增加四倍相关（风险比 [RR] 4.01，置信区间 [CI] 1.17 至 13.78，P = 0.03），但在使用混合技术时，温水灌注与空气灌注之间的这种风险并没有显著差异（即，在遇到困难时，例如观察不佳，短暂使用空气）。温水灌注和空气灌注与相似的盲肠插管时间（P = 0.62）和腺瘤检出率（P = 0.49）相关，但使用温水灌注的患者经历的疼痛明显减轻（P ＜0.00001），且要求镇静和/或镇痛的比例明显降低（RR 0.48，CI 0.35 至 0.66，P ＜0.00001）。
尽管温水灌注更频繁地导致盲肠插管失败，但技术修改，即短时间的空气注入，可以消除这种情况。与标准空气注入相比，温水灌注引起的疼痛较轻，减少了镇静/镇痛的需求，并提高了患者对结肠镜检查的接受度，没有额外的不良反应。
