以二氧化碳为媒介的老年人结肠镜检查的安全性和舒适性

目的分析评价二氧化碳（C02）为媒介的结肠镜检查应用于老年患者的安全性和舒适性。方法这是一项随机双盲对照研究。选取110例老年人,随机分为以空气为媒介的结肠镜组（n=55）和以CO2为媒介的结肠镜组（n=55）。通过腹痛和腹胀的问卷调查、腹部平片肠管积气程度、经皮CO2分压连续测定等结果,分析比较两组间的差异性。结果CO2组平均插入时间短,且成功率高,与空气组比较差异有统计学意义[（7．0±4．9）vs（9．0±3．7）min;P〈0．05];结肠镜检查后5,10,15,20min不同时间点进行的腹痛、腹胀的问卷调查评分中,C02组的评分明显低于空气组,差异有统计学意义[5min：（15．4±2．1）VS（63．5±13．5）,10min：（5．1±1．3）vs（60．3±10．9）,15min：（0．5±0．7）vs（58．6±11．6）,20min：（0．0±O．7）vs（50．4±8．2）;P〈0．01];C02组的肠管扩张程度评分明显低于空气组,差异有统计学意义[（1．2±0．5）vs（3．6±0．9）;P〈0．05];结肠镜检查前、到达回盲部、退回至直肠、检查结束后10min4个时间点记录经皮呼气末CO2分压,差异均无统计学意义。结论与以空气为媒介的结肠镜比较,以CO2为媒介的结肠镜检查应用于老年人,安全可靠,并且具有痛苦小、操作时间短、耐受性好的显著优势。     

ERCP术中注入二氧化碳与空气的安全性及有效性比较

目的 探讨在ERCP术中CO2作为注入气体的安全性及有效性.方法 选取2012年1月至12月南京军区福州总医院消化内科在全麻下行ERCP的患者140例.采用随机双盲对照法,按照患者检查顺序,依据事先选定好的随机数字分成CO2注入组（CO2组）和空气注入组（空气组）,分别为65例和75例.采用视觉模拟评分（VAS）评价两组术后1、3、6、24h腹痛和腹胀程度,监测术前、术中、检查结束时、术后24 h的心率、血压、血氧饱和度、动脉血二氧化碳分压.对比检查前后腹部平片显示的肠管胀气情况,记录术前及术后1h的腰围、操作时间、苏醒时间、术中与术后并发症.结果 CO2组术后3 h腹痛VAS为（4.08±1.36）分,显著低于空气组的（4.59±1.66）分（P＜0.01）;术后1、3、6h腹胀VAS分别为（1.78±1.90）、（0.72±1.15）、（0.12±0.45）分,显著低于空气组的（3.53±2.71）、（2.51±2.04）、（0.84±1.24）分（P值均＜0.05）;术中血氧饱和度为（93.29±1.40）％,显著低于空气组的（93.52±1.06）％（P＜0.01）;术后1h腰围增加（2.48±1.33） cm,显著低于空气组的（3.56±2.13）cm（P=0.00）;平均苏醒时间为（11.2±2.5）min,显著长于空气组的（9.7±1.7） min（P =0.00）.腹部平片提示空气组的肠管胀气较CO2组严重（P=0.04）.结论 ERCP中注入CO2是安全、有效的,在减轻患者检查后的腹痛、腹胀等方面优于空气注入法.     

二氧化碳注气在ERCP诊疗中的应用价值研究

目的探讨ERCP诊治过程中CO2代替普通空气经内镜注入的安全性和应用价值。方法102例患者随机分为CO2注气组（52例）和空气注气组（50例）,观察并发症发生情况及术中生命体征变化情况,对比分析2组术后1h肠管扩张程度构成情况以及术后1、2、6h腹痛和腹胀程度VAS评分结果。结果2组均顺利完成ERCP诊疗,均未出现ERCP相关并发症,2组术中平均心率及血氧饱和度比较差异无统计学意义（P〉0．05）。CO2注气组术后1h中一重度肠管扩张14例（26．9％）,明显低于空气注气组的56．0％（28／50）（x2=11．61,P=0．009）。术后1h腹痛、腹胀程度VAS评分CO。注气组均低于空气注气组,但差异均无统计学意义（P〉0．05）。CO2注气组术后2h、6h腹痛程度VAS评分分别为（7．4±2．2）分和（9．6±3．7）分,空气注气组分别为（18．7±4．6）分和（20．1±4．5）分,CO2注气组均明显低于空气注气组（P〈0．05）;CO2注气组术后2h、6h腹胀程度VAS评分分别为（7．6±3．6）分和（8．9±3．7）分,空气注气组分别为（18．3±4．1）分和（19．4±4．2）分,CO2注气组亦均明显低于空气注气组（P〈0．05）。结论ERCP诊疗术中应用CO2代替普通空气注入是安全的,具有较好的临床应用价值。     

结肠镜检查中减轻腹痛方法的临床研究进展

结肠镜是目前结直肠癌筛查的首选方式。传统结肠镜在注入空气时会使肠管过度延展、拉长,可致患者明显腹痛。腹部按压、体位变化、注CO_2结肠镜、注水式结肠镜、镇静结肠镜等方法均可不同程度减轻或消除结肠镜检查中的腹痛,提高患者的舒适度。此文对结肠镜检查中减轻腹痛方法的研究进展作一综述。     

二氧化碳应用于结肠息肉高频电凝电切术的临床效果

目的:本实验以空气为对照,结肠息肉高频电凝电切术时注入CO2,观察其安全性与有效性.方法:将140例接受肠息肉治疗患者随机分成CO2组(70例)和空气组(70例),息肉切除时分别注入CO2和空气,记录每组患者肠镜检查前、检查过程中及检查后的动脉血CO2分压,采用直观模拟评分(visual analog score,VA S)量表对结肠镜检查检查后1、3、6和24 h腹胀腹痛严重程度进行评分并记录,记录两组患者完成时间及24 h后满意度,组间比较采用t检验,计数资料用?2检验进行统计学分析.结果:两组患者均顺利完成息肉电切术,CO2组血CO2分压检查前(38.91 mm Hg±5.02mm Hg)、检查中(40.54 mm Hg±4.82 mm Hg)及检查后(39.46 mm Hg±5.15 mm Hg)与空气组血CO2分压检查前(38.52 mm Hg±4.40mm Hg)、检查中(38.87 mm Hg±4.58 mm Hg)及检查后(38.74 mm Hg±4.21 mm Hg)对比无统计学差异(P0.05);而检查中、后1、3和6 h的CO2组患者腹胀腹痛程度平均VAS分值均明显低于空气组(P0.05).两组患者完成时间无统计学差异(P0.05);CO2组患者24 h后满意度调查明显优于空气组.结论:结肠息肉高频电凝电切术中注入CO2可明显减轻患者术中术后腹痛腹胀,不会引起CO2潴留,不影响治疗时间,提高患者满意度,值得临床推广使用.     

高乌甲素复合芬太尼用于老年患者术后镇痛的临床观察

目的观察氢溴酸高乌甲素复合芬太尼用于老年患者术后静脉自控镇痛的临床效果与不良反应。方法选择100例手术的老年患者,随机分为两组。Ⅰ组（50例）采用氢溴酸高钾素复合芬太尼术后镇痛,镇痛液配方为：芬太尼0.5mg＋高乌甲素24mg＋氟哌利多5mg＋0.9%氯化钠注射液共100ml;Ⅱ组（50例）采用芬太尼作术后镇痛,镇痛液配方为：芬太尼1.0mg＋氟哌利多5mg＋0.9%氯化钠注射液共100ml。两组镇痛泵设置：持续输注2ml/h,追加量2ml/次,锁定15min。分别于6、12、24、48h观察镇痛效果及不良反应。结果两组患者VAS评分无明显差异（P〉0.05）;镇静评分Ⅱ组明显高于Ⅰ组（P〈0.05）;术后恶心、呕吐发生率Ⅱ组明显高于Ⅰ组（P〈0.05）。结论高乌甲素复合芬太尼用于老年患者术后镇痛,临床镇痛效果确切,不良反应较少。     

注水结肠镜与注气结肠镜检查240例临床对照研究

目的探讨注气结肠镜与注水结肠镜检查的舒适度及操作性。方法选取2016年6-9月在北部战区总医院内窥镜科接受结肠镜检查的240例患者,将其随机分为注气结肠镜检查组和注水结肠镜检查组,比较两组患者一般情况,记录检查的达盲率、时间、腹痛评分,随访腹痛、腹胀及再次检查是否选择无痛结肠镜意愿。结果注气组与注水组在一般情况、进镜成功率、进镜深度、检查后腹痛情况、再次检查选择无痛结肠镜等方面差异无统计学意义(P0.05);注气组疼痛评分明显高于注水组(P=0.001),注水组的进镜时间、退镜时间及操作总时间明显高于注气组(P0.001,P=0.013,P0.001),检查后1 h腹胀程度注气组明显高于注水组(P0.001),检查后6 h腹胀程度两组间差异无统计学意义(P0.05)。结论注水结肠镜检查可明显减轻患者腹痛和检查后腹胀不适感,但其操作时间较注气法延长。     

非药物护理干预在老年患者术后疼痛处理中的作用

目的探讨非药物护理干预在老年患者术后疼痛处理中的作用。方法采用视觉模拟评分法（VAS）对32名老年髋关节周围骨折患者术后疼痛进行评分。根据镇痛处理方法的不同，随机分为药物镇痛组、单纯护理干预组及药物镇痛联合护理干预组（联合组），观察三组患者术后不同时间疼痛评分的变化情况。结果三组患者术后4h的平均VAS评分基本相同。联合组术后8h的VAS评分明显低于其他两组，三组间的VAS疼痛评分具有显著性差异（P〈0.05）。结论护理干预联合药物镇痛治疗能有效地减轻老年患者术后疼痛，提高老年患者术后早期生理、心理舒适度。     

二氧化碳注入联合水交换在肠镜检查中的应用效果分析

目的探究二氧化碳注入联合水交换在肠镜检查中的应用效果。方法选择2018年2至11月新疆军区总医院北京路临床部拟行结肠镜检查的患者190例,随机分为空气组(63例)、水交换组(63例)和联合组(64例)。空气组患者采用常规注气结肠镜检查;水交换组患者采用注水结肠镜检查;联合组患者采用二氧化碳气泵联合注水结肠镜检查。比较三组的结肠镜检查情况、检查后不适症状间的差异。结果水交换组和联合组的退镜时间和麻醉需求率均显著低于空气组,两组的盲插成功率和Boston评分均明显高于空气组(P 0. 05);联合组的退镜时间明显低于水交换组,差异均有统计学意义(P 0. 05)。三组的进镜时间和检出率间均无统计学差异(P0. 05)。水交换组、联合组检查中及检查后1 h的VAS评分和腹胀评分显著低于空气组(P 0. 05)。检查中,联合组的VAS评分低于水交换组(P 0. 05),两组的腹胀评分比较无统计学差异(P 0. 05);检查后1 h,联合组的VAS评分和腹胀评分均显著低于水交换组(P 0. 05)。结论二氧化碳注入联合水交换可明显减少退镜时间和麻醉需求,有效改善清洁度,减轻患者的疼痛和腹胀程度。     

结肠镜检查中注水与注空气效果对比的Meta分析

结肠镜检查是诊断结直肠疾病最可靠的方式之一,然而常规空气灌注式结肠镜检查往往会造成不同程度的腹痛、腹胀等不适,导致一些患者不愿接受检查,甚至可能因惧怕检查而延误严重肠道疾病的最佳诊治时机,因此探求更好的结肠镜检查方式具有重要临床意义。     

Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective,randomized, double blind,controlled trial evaluating a new commercially available CO(2) delivery system

BACKGROUND: Abdominal pain after colonoscopy is a common, distressing symptom resulting from bowel distension by insufflated gas. CO(2), unlike air, is rapidly cleared from the colon by passive absorption. A commercially available CO(2) delivery system has only recently become available. The effects of CO(2) and air insufflation on residual bowel gas and postprocedure pain were compared. METHODS: One hundred patients were randomized to undergo colonoscopy with insufflation of air (n = 51) or CO(2) (n = 49) by means of a regulator; 97 patients completed the study. Patients with active GI bleeding, inflammatory bowel disease, or previous colectomy were excluded. Pain scores (ordinal scale: 0 = none, to 5 = extreme) were recorded immediately after colonoscopy and at 1, 6, and 24 hours. Residual colonic gas was evaluated on abdominal radiographs at 1 hour. RESULTS: Residual colonic gas and postprocedural pain at 1 and 6 hours were significantly less in the CO(2) group. 71% of patients insufflated with room air had colonic distension in excess of 6 cm versus 4% for those in the CO(2) group. 94% of patients insufflated with CO(2) had minimal colonic gas versus 2% in whom air was used (p < 0.0001). Of patients insufflated with air, 45% and 31% had pain at, respectively, 1 hour and 6 hours, versus 7% and 9%, respectively, for those insufflated with CO(2) (respectively, p < 0.0001 and p < O.02). No complications resulted from use of the CO(2) delivery system. CONCLUSIONS: Insufflation of CO(2) rather than air significantly reduces abdominal pain and bowel distension after colonoscopy. CO(2) may be insufflated safely and effectively with the new CO(2) delivery system.     

A randomized controlled trial of total colonic decompression after colonoscopy to improve patient comfort

OBJECTIVES: Bloating occurring after colonoscopy may cause significant discomfort in some patients. We sought to determine whether total colonic decompression decreased bloating and improved comfort after colonoscopy. METHODS: Consecutive outpatients undergoing elective colonoscopy were randomized to total colonic decompression or to the control group after completion of the routine colonoscopy. The colonoscope was advanced again to the cecum and the air aspirated during withdrawal in patients randomized to decompression and the procedure was terminated without decompression in control patients. Pain and bloating was assessed in the recovery room and in 24-48 h using a five-point scale. RESULTS: Sixty-five patients were randomized to decompression and 61 were randomized to the control group. The baseline demographic and procedural characteristics were similar between the two groups, but decompression took significantly longer (median, 17 min vs 14 min, p = 0.0002). Seventy-five percent of the decompression group and 80% of the control group denied any pain during colonoscopy. Significantly fewer patients from the decompression group complained of bloating after the procedure (25% vs 59%, p < 0.001) when questioned in the recovery room. However, comparable patients complained of postprocedure bloating when questioned in 24-48 h after the procedure (45% of decompression group vs 47% of control group, p = 0.86). The nurse and the endoscopist were poor at predicting the patient's bloating and significantly overestimated the level of pain. CONCLUSIONS: Total colonic decompression does not significantly reduce bloating after colonoscopy when assessed 24-48 h after the procedure.     

Carbon dioxide insufflation during colonoscopy in deeply sedated patients

AIM: To compare the impact of carbon dioxide (CO₂) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS: Patients referred for colonoscopy were randomized to receive either CO₂ or air insufflation during the procedure. Both the colonoscopist and patient were blinded to the type of gas used. During the procedure, insertion and withdrawal times, caecal intubation rates, total sedation given and capnography readings were recorded. The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3). Patients then graded their level of discomfort and abdominal bloating using a similar VAS. Complications during and after the procedure were recorded.RESULTS: A total of 142 patients were randomized with 72 in the air arm and 70 in the CO₂ arm. Mean age between the two study groups were similar. Insertion time to the caecum was quicker in the CO₂ group at 7.3 min vs 9.9 min with air (P = 0.0083). The average withdrawal times were not significantly different between the two groups. Caecal intubation rates were 94.4% and 100% in the air and CO₂ groups respectively (P = 0.012). The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO₂) (P = 0.0155) and by the patient 0.82 (air) and 0.46 (CO₂) (P = 0.0228). The level of abdominal bloating was 0.97 (air) and 0.36 (CO₂) (P = 0.001). Capnography readings trended to be higher in the CO₂ group at the commencement, caecal intubation, and conclusion of the procedure, even though this was not significantly different when compared to readings obtained during air insufflation. There were no complications in both arms.CONCLUSION: CO₂ insufflation during colonoscopy is more efficacious than air, allowing quicker and better cecal intubation rates. Abdominal discomfort and bloating were significantly less with CO₂ insufflation.     

Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit

BACKGROUND & AIMS: The relationship between the sensation of bloating, often ranked as the most bothersome symptom by patients with irritable bowel syndrome (IBS), and actual distention manifest as an increase in abdominal girth is controversial. Investigation of this problem has been hampered by the lack of a reliable ambulatory technique to measure abdominal girth. The aim of this study was to use the technique of abdominal inductance plethysmography to compare diurnal variation in girth in IBS patients and healthy volunteers, relating these changes to the sensation of bloating. METHODS: Abdominal girth was recorded for 24 hours in 20 IBS-constipation (age, 18-73 y), 20 IBS-diarrhea (age, 25-62 y) and 10 IBS-alternating (age, 21-59 y) female patients meeting Rome II criteria and 20 healthy female controls (age, 18-67 y). All subjects pursued normal daily activities, recording their symptoms of bloating and pain together with bowel habit. RESULTS: All patients with IBS, irrespective of bowel habit, reported significantly greater bloating than controls (P < .0001). Forty-eight percent of patients also showed distention beyond the 90% control range, with this being most prominent in IBS-constipation. Bloating correlated strongly only with distention in IBS-constipation (r > or = 0.48; P < or = .02). Neither bloating nor distention in IBS was related to body mass index, age, parity, or psychologic status. CONCLUSIONS: Abdominal distention is a clearly definable phenomenon in IBS that can reach 12 cm. However, it only occurs in half of patients reporting bloating, and the 2 only correlate in IBS-constipation. Bloating and distention may differ pathophysiologically and this appears to be reflected in the bowel habit subtype.     

Carbon dioxide insufflation during withdrawal of the colonoscope improved postprocedure discomfort: a prospective, randomized, controlled trial

In colonoscopy, the question of when and how to use carbon dioxide (CO(2)) insufflation remains uncertain. Inspection for the pathological changes during colonoscopy takes place during the withdrawal of the scope. This study aimed to determine whether CO(2) insufflation only at the withdrawal of the colonoscope has an effect comparable to that of CO(2) usage throughout the course of the procedure. Symptomatic patients were randomized in three groups: (1) patients given air insufflation (A; n = 33); (2) patients given CO(2) insufflation only at the time of scope withdrawal (CW; n = 33); and (3) patients given the CO(2) insufflation (C; n = 34) for the whole course of the colonoscopy. Patients were requested to answer questionnaires about their pain score during, at the end, and 1 h after the colonoscopy by using a pain numerical scale ranging from 0 to 10. The disparities of the pain score were noted at the end of the procedure and 1 h after the procedure (p = 0.026 and p < 0.001, respectively). We further analyzed the scores between two of the three groups. Both CW (vs. A; procedure end: p = 0.012, 1 h after: p = 0.001) and C (vs. A; procedure end: p = 0.072, 1 h after: p < 0.001) showed less postprocedure pain when compared with the group A. The pain score between CW and C were similar at each time segment (procedure end: p = 0.555, 1 h after: p = 0.491). CO(2) insufflation merely at the withdrawal of the colonoscope improved postprocedural abdominal discomfort and the effect was not inferior to that of full course CO(2) insufflation.     

A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation

BACKGROUND: Endoscopic submucosal dissection (ESD) is accepted as one of the treatments for en bloc resection of large superficial colorectal lesions. This procedure is performed by using air insufflation, is time consuming, and is associated with severe abdominal discomfort. The safety and efficacy of carbon dioxide (CO(2)) insufflation during colonoscopy already has been assessed in some trials. OBJECTIVE: To assess the safety and efficacy of CO(2) insufflation instead of air insufflation during colorectal ESD with the patient under conscious sedation. DESIGN: A case-control series with a historical control. PATIENTS: A total of 35 consecutive patients were enrolled in this study. Another 35 consecutive patients who previously received colorectal ESDs by using air insufflation were included as a historical control. INTERVENTIONS: Arterial partial pressure of CO(2) (pCO(2)) was measured before and after each procedure with the total dose of midazolam used as an index of abdominal discomfort. MAIN OUTCOME MEASUREMENTS AND RESULTS: The mean (standard deviation [SD]) operation time was 90 +/- 57 minutes in the CO(2) group and 100 +/- 80 minutes in the control group (not significant). In the CO(2) group, the mean (SD) dose of midazolam was significantly lower than that of the control group; 5.6 +/- 4.9 mg and 9.7 +/- 5.9 mg, respectively (P = .005). Blood analysis revealed a slight pCO(2) elevation in the CO(2) group; however, only 2 patients complained of mild abdominal discomfort. LIMITATIONS: Abdominal discomfort and pCO(2) were not evaluated in the control group. CONCLUSIONS: This study strongly suggests that CO(2) insufflation is safe and effective during lengthy colonic endoscopic procedures, eg, ESD, with the patient under conscious sedation.     

Fructose-induced breath hydrogen in patients with fruit intolerance

GOALS: To measure bloating score, flatus passage, and hydrogen production after oral fructose in patients with history of fruit intolerance and compare these parameters with those in normal controls. BACKGROUND: Some patients complain of abdominal distention and excessive flatus after ingesting certain fruits such as mango, persimmon, and grapes but not after eating apricots and melon. STUDY: We recorded breath hydrogen, flatus passage and bloating after 20 g fructose in 8 patients with history of fruit intolerance and 4 healthy controls. Breath hydrogen was measured every 15 minutes for 480 minutes using EC-60 gastrolyzer. Number of passage of flatus was recorded over 8 hours. Severity of abdominal distention on a scale of 1 to 10 was noted. RESULTS: The patients with fruit intolerance produced breath hydrogen 1745.2+/-7.8 parts per million, passed flatus 13.8+/-0.3 times, and had bloating score of 5.7+/-0.1. The healthy controls produced breath hydrogen 712.5+/-5.8 parts per million in 8 hours, passed flatus 7.2+/-0.5 time, and had bloating score of 2.7+/-0.2. CONCLUSIONS: After 20 g fructose, patients with history of fruit intolerance produce more breath hydrogen, pass flatus more frequently, and have a higher bloating score compared with healthy controls.     

Prokinetic effects in patients with intestinal gas retention

BACKGROUND & AIMS: We have previously shown that patients with irritable bowel syndrome (IBS) have impaired transit of intestinal gas loads. Because abnormal gas retention can be experimentally reproduced in healthy subjects by pharmacological inhibition of gut motility, we hypothesized that impaired gas transit and retention can be reciprocally corrected by pharmacologically stimulating intestinal propulsion. METHODS: In 28 patients with abdominal bloating (14 IBS, 14 functional bloating) and in 14 healthy subjects, gas evacuation and perception of jejunal gas infusion (12 mL/min) were measured. After 2 hours, in 20 patients we tested the effect of intravenous neostigmine (0.5 mg) vs. intravenous saline administered blindly and randomly at a 1-hour interval. RESULTS: After 2 hours of gas infusion, patients with IBS and functional bloating alike exhibited significant gas retention (418 +/- 86 mL), abdominal symptoms (2.7 +/- 0.5 score), and objective distention (8 +/- 2 mm girth increment), in contrast to healthy controls, who experienced none (46 +/- 102 mL retention, 0.4 +/- 0.3 symptom score, and 3 +/- 1 mm distention; P < 0.05 for all). Neostigmine produced immediate clearance of gas retained within the gut (603 +/- 53 mL/30 minutes vs. 273 +/- 59 mL/30 minutes after saline; P < 0.05) and by 1 hour reduced gas retention (by 373 +/- 57 mL), abdominal symptoms (by 1.1 +/- 0.5 score), and distention (by 6 +/- 1 mm; P < 0.05 for all), whereas intravenous saline produced no effects. CONCLUSIONS: In patients with intestinal gas retention, pharmacological stimulation of intestinal propulsion improves gas transit, abdominal symptoms, and distention.