温水或二氧化碳气体在困难结肠镜检查中的应用效果比较

Comparison of the application effect of Warm-water or Carbon Dioxide Insufflation in difficult colonoscopy

摘要:

目的 对比注温水或二氧化碳（CO₂）气体在困难结肠镜检查中的安全性和临床价值。方法 选取2021年5月－2023年10月于该院门诊行非麻醉困难结肠镜检查的患者150例，随机分为注温水组（W组，n = 50）、注CO₂气体组（C组，n = 50）和注空气组（A组，n = 50）。比较3组患者进镜时间、检查中及结束后20 min、结束后1 h腹痛视觉模拟评分法（VAS）、插管成功率、息肉检出率、再检查意愿率和操作过程中是否需外界辅助等。另外随机选取A组和C组部分患者，比较检查前、达回盲部和检查后20 min呼气末二氧化碳分压（PetCO₂），以了解体内CO₂潴留情况。结果 A组检查进镜时间长于W组和C组，且W组短于C组；A组各时间点腹痛VAS高于W组和C组，且W组检查中腹痛VAS低于C组；A组插管成功率和再检查意愿率低于W组和C组，差异均有统计学意义（P < 0.05），W组和C组检查结束后20 min和1 h腹痛VAS、插管成功率和再检查意愿率比较，差异均无统计学意义（P > 0.05）。W组需要助手腹部按压率明显低于A组和C组，转换体位率明显低于A组，差异有统计学意义（P < 0.05）。3组患者息肉检出率比较，差异无统计学意义（P > 0.05）。C组各时点的PetCO₂均在正常范围内，与A组比较，差异无统计学意义（P > 0.05）。结论 与注空气法相比，注水或CO₂气体在困难结肠镜检查中成功率高，安全性好，可减轻患者腹部不适感，特别是注水肠镜更适合在基层医院推广。

Abstract:

Objective To compare the safety and clinical value of warm-water infusion or carbon dioxide (CO₂) insufflation in difficult colonoscopy.Methods A collection of 150 patients from May 2021 to October 2023 who underwent unsedated and difficult colonoscopy were randomly divided into warm-water insufflation group (W group, n = 50), CO₂ insufflation group (C group, n = 50) and air insufflation group (A group, n = 50). Record the cecal insertion time, the abdominal pain score during the examination and 20 min and 1 h after the examination, the success rate of intubation, the polyps detection rate, the willingness to re-examine and the need for assistance in the three groups. Some patients were randomly selected to record partial pressure of end-tidal carbon dioxide (PetCO₂) of pre-examination, the ileocecal and 20 min after the examination to understand CO₂ retention in the body.Results The cecal insertion time of group A was longer than that of group W and group C, and group W was shorter than group C. The abdominal pain score of group A was higher than that of group W and group C at each time point，and the abdominal pain score during the examination was lower in the group W compared with group C. The success rate of intubation and the willingness to re-examination in the group A were lower than those in group W and group C, The above differences were statistically significant (P < 0.05). However, there was no statistical difference between the the group W and group C in terms of success rate of intubation, willingness to re-examine, and abdominal pain score at 20 minutes and 1 hour after the examination (P > 0.05). In the group W, significantly fewer patients required abdominal compression compared with the other two groups, and the rate of position conversion was significantly lower than that in group A (P < 0.05).There was no significant difference in the detection rate of polyps among the three groups (P > 0.05). In addition, PetCO₂ of group C was within the normal range at all time points, and there was no statistical difference compared with the group A (P > 0.05).Conclusion Compared with the air group, water or CO₂ insufflation colonoscopy is safe and has a high success rate in difficult colonoscopy. It can reduce the patient’s abdominal discomfort, especially water insufflation colonoscopy is more suitable for promotion in primary hospitals.