Dike Chinenye R, Rahhal Riad, Bishop Warren P
Division of Pediatric Gastroenterology, Hepatology, Pancreatology and Nutrition, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital and Medical Center at University of Nebraska Medical Center, Omaha, NE.
J Pediatr Gastroenterol Nutr. 2020 Aug;71(2):211-215. doi: 10.1097/MPG.0000000000002724.
Distension of the gastrointestinal lumen is crucial for visualization and advancement during endoscopic procedures. An increasing number of pediatric centers now use carbon dioxide (CO2) preferentially over air as many adult studies and a few pediatric studies have concluded that CO2 is better tolerated than air, especially for colonoscopy.
The aim of the study was to determine if CO2 is as safe and as effective as air and if it reduces abdominal discomfort and distension in children undergoing upper endoscopy and colonoscopy.
Double blinded, prospective, randomized clinical study. Patient- and nursing-reported outcomes of pain and distension were recorded. End tidal CO2 (EtCO2) was monitored continuously with a CO2-sampling nasal cannula for patients undergoing procedural sedation and via the endotracheal tube for those who were intubated.
One hundred seventy-eight patients with 180 procedures were enrolled, 91 procedures were randomized to receive CO2, and 89 to air. Groups did not differ significantly with respect to nursing-assessed abdominal discomfort, change in girth from baseline, or endoscopist-perceived ease of inflation. Use of CO2 was associated with transient spikes in the EtCO2 (≥60 mmHg) in a significant number of patients during sedated upper endoscopy without endotracheal intubation. There was a reduction of bloating and flatulence for all procedures in the CO2 group.
The benefits of using CO2 for insufflation were minimal in our patients. The observed transient elevations of EtCO2 during sedated upper endoscopy raise concerns of possible systemic hypercarbia. The wisdom of its routine use for all pediatric endoscopic procedures is questioned.
胃肠道管腔扩张对于内镜检查过程中的视野观察和推进操作至关重要。越来越多的儿科中心现在优先使用二氧化碳（CO₂）而非空气，因为许多成人研究和一些儿科研究得出结论，CO₂比空气耐受性更好，尤其是在结肠镜检查中。
本研究的目的是确定CO₂是否与空气一样安全有效，以及它是否能减轻接受上消化道内镜检查和结肠镜检查的儿童的腹部不适和腹胀。
双盲、前瞻性、随机临床研究。记录患者和护士报告的疼痛和腹胀结果。对于接受程序镇静的患者，使用CO₂采样鼻导管持续监测呼气末二氧化碳（EtCO₂）；对于插管患者，则通过气管内导管进行监测。
共纳入178例患者，进行了180例操作，其中91例操作随机分配接受CO₂，89例接受空气。在护士评估的腹部不适、腰围相对于基线的变化或内镜医师感知的充气难易程度方面，两组之间没有显著差异。在未插管的镇静上消化道内镜检查期间，大量患者使用CO₂与EtCO₂短暂升高（≥60 mmHg）有关。CO₂组所有操作的腹胀和肠胃胀气均有所减轻。
在我们的患者中，使用CO₂进行充气的益处微乎其微。在镇静上消化道内镜检查期间观察到的EtCO₂短暂升高引发了对可能出现全身性高碳酸血症的担忧。其在所有儿科内镜检查程序中常规使用的合理性受到质疑。
