二氧化碳充气在无镇静患者结肠镜插入期间不会降低疼痛评分：一项随机对照试验。

Carbon dioxide insufflation does not reduce pain scores during colonoscope insertion in unsedated patients: a randomized, controlled trial.

机构信息

Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

出版信息

Gastrointest Endosc. 2013 Jan;77(1):79-89. doi: 10.1016/j.gie.2012.09.012.

DOI:10.1016/j.gie.2012.09.012

PMID:23261097

Abstract

BACKGROUND

CO(2) is rapidly absorbed from the colon and eliminated via the lung. Insufflation of CO(2) instead of air during colonoscopy can reduce distention-induced pain.

OBJECTIVE

This study aimed to evaluate the effects of CO(2) insufflation on pain during intubation and extubation and to identify predictors of pain and discomfort during colonoscope insertion.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Single tertiary medical center in Taiwan.

PATIENTS

A total of 193 patients enrolled from September 2010 through June 2011.

INTERVENTIONS

Colonoscope insertion with either air or CO(2) insufflation. CO(2) was used for extubation in both groups.

MAIN OUTCOME MEASUREMENTS

The main outcome measurement was pain, recorded on a 10-point visual analog scale (VAS) for left-sided colonoscope insertion and right-sided colonoscope insertion and at 1, 3, 6, and 24 hours post-procedure. Colonoscope cecal intubation time and extubation time, completeness of intubation, and loop formation were also assessed.

RESULTS

CO(2) insufflation during colonoscope intubation was used in 98 patients and air in 97 patients. The mean pain scores during intubation were low (2-3) for patients undergoing air insufflation and were not reduced further in patients receiving CO(2). A mean pain score of 0 was reported by both groups for all postprocedure time points. Multivariate analysis identified sex, loop formation of the sigmoid colon, time to reach the transverse colon, and requested sedation as factors that significantly affect VAS pain scores.

LIMITATIONS

This study was limited in scope to a single medical center with experienced endoscopists.

CONCLUSIONS

We detected no significant benefit to the use of CO(2) insufflation compared with air insufflation during intubation for colonoscopy performed by experienced colonoscopists. The absence of postprocedure pain in both groups supports previous observations that CO(2) insufflation during extubation is effective in reducing postprocedure pain. Female sex and loop formation were identified as key factors influencing pain scores on colonoscope insertion. (

CLINICAL TRIAL REGISTRATION NUMBER

TSGHIRB-099-05-081.).

摘要

背景

CO₂ 从结肠迅速吸收并通过肺部排出。在结肠镜检查中使用 CO₂ 而不是空气充气可以减轻充气引起的疼痛。

目的

本研究旨在评估 CO₂ 充气对插管和拔管过程中疼痛的影响，并确定结肠镜插入过程中疼痛和不适的预测因素。

设计

前瞻性、随机、对照试验。

设置

台湾一家三级医疗中心。

患者

2010 年 9 月至 2011 年 6 月期间共纳入 193 例患者。

干预措施

使用空气或 CO₂ 充气进行结肠镜插入。两组均使用 CO₂ 进行拔管。

主要观察指标

主要观察指标是疼痛，通过 10 分视觉模拟量表（VAS）记录左侧结肠镜插入和右侧结肠镜插入时以及术后 1、3、6 和 24 小时的疼痛，还评估了结肠镜盲肠插管时间和拔管时间、插管完成情况和环形成情况。

结果

98 例患者接受 CO₂ 充气，97 例患者接受空气充气。接受空气充气的患者插管时疼痛评分较低（2-3），而接受 CO₂ 充气的患者疼痛评分无进一步降低。两组患者在所有术后时间点均报告平均疼痛评分为 0。多变量分析确定性别、乙状结肠环形成、到达横结肠的时间和要求镇静作为显著影响 VAS 疼痛评分的因素。