Takada Jun, Araki Hiroshi, Onogi Fumito, Nakanishi Takayuki, Kubota Masaya, Ibuka Takashi, Shimizu Masahito, Moriwaki Hisataka
Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan,
Surg Endosc. 2015 Jul;29(7):1963-9. doi: 10.1007/s00464-014-3892-0. Epub 2014 Oct 16.
Carbon dioxide (CO2) insufflation is effective for gastric endoscopic submucosal dissection (ESD). However, its safety is unknown in patients with pulmonary dysfunction. This study aimed to investigate the safety of CO2 insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation.
We analyzed 322 consecutive patients undergoing ESD using CO2 insufflation (1.4 L/min) for gastric lesions. Pulmonary dysfunction was defined as a forced expiratory volume in 1.0 s/forced vital capacity (FEV1.0%) <70% or vital capacity <80%. Transcutaneous partial pressure of CO2 (PtcCO2) was recorded before, during, and after ESD.
In total, 127 patients (39%) had pulmonary dysfunction. There were no significant differences in baseline PtcCO2 before ESD, peak PtcCO2 during ESD, and median PtcCO2 after ESD between the pulmonary dysfunction group and normal group. There was a significant correlation between PtcCO2 elevation from baseline and ESD procedure time (r = 0.22, P < 0.05) only in the pulmonary dysfunction group. In patients with FEV1.0% <60%, the correlation was much stronger (r = 0.39, P < 0.05). Neither the complication incidences nor the hospital stay differed between the two groups. CO2 narcosis or gas embolism was not reported in either group.
CO2 insufflation during gastric ESD in patients with pulmonary dysfunction under conscious sedation is safe with regard to complication risk and hospital stay. However, in patients with severe obstructive lung disease, especially in those with FEV1.0% <60%, longer procedure time may induce CO2 retention, thus requiring CO2 monitoring.
二氧化碳（CO₂）充气在胃内镜黏膜下剥离术（ESD）中是有效的。然而，其在肺功能障碍患者中的安全性尚不清楚。本研究旨在探讨在清醒镇静下，肺功能障碍患者行胃ESD时CO₂充气的安全性。
我们分析了连续322例行胃病变ESD并使用CO₂充气（1.4 L/分钟）的患者。肺功能障碍定义为1秒用力呼气容积/用力肺活量（FEV₁.₀%）<70%或肺活量<80%。在ESD前、术中及术后记录经皮二氧化碳分压（PtcCO₂）。
总共127例患者（39%）有肺功能障碍。肺功能障碍组和正常组在ESD前的基线PtcCO₂、ESD期间的峰值PtcCO₂以及ESD后的中位PtcCO₂方面无显著差异。仅在肺功能障碍组中，PtcCO₂相对于基线的升高与ESD手术时间之间存在显著相关性（r = 0.22，P < 0.05）。在FEV₁.₀%<60%的患者中，相关性更强（r = 0.39，P < 0.05）。两组的并发症发生率和住院时间均无差异。两组均未报告CO₂麻醉或气体栓塞。
在清醒镇静下，肺功能障碍患者行胃ESD时CO₂充气在并发症风险和住院时间方面是安全的。然而，在严重阻塞性肺疾病患者中，尤其是FEV₁.₀%<60%者，较长的手术时间可能会导致CO₂潴留，因此需要进行CO₂监测。
