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。

A randomized controlled study on carbon dioxide insufflation during ERCP

Objective To investigate the safety and efficacy of carbon dioxide ( CO2 ) insufflation during ERCP.Methods Between January and August 2011,a total of 102 consecutive patients who underwent ERCP were randomized to accept CO2 insufflation ( n =52 ) of air insufflation ( n =50 ) during the procedure.ERCP was carried out with the same instrument by an expert endoscopist who was blinded to the insufflation gas used and the procedure was controlled at 30 minutes to 1 hour.The heart rate,oxygen saturation of the patient was continuously monitored during the procedure.Before the procedure and 1 hour after the end of operation,abdominal X-ray was taken to evaluate the width of intestine,and the degree of intestinal expansion was defined as normal,mild,moderate and severe according to the width increased.A questionnaire with 100 mm visual analogue scale (VAS) was used to quantify the abdominal pain and distention experienced at 1 hour,2 hours,and 6 hours after the procedure.The patients' vital signs,bowel dilatation,the average operating time,abdominal pain score and distention score on VAS,and complications in 2 groups were analyzed.Results The baseline characteristics of 2 groups were comparable.ERCP was successfully performed in all the patients and no complication was observed.In CO2 group,the average operating time,mean heart rate and oxygen saturation were (45.2 ± 10.6) min,( 102.2 ± 10.3 ) bpm and ( 99.5 ± 0.5)％,which were (48.5 ± 11.2) min,( 100.3 ± 11.4) bpm and (98.9 ±0.6)％,respectively,in air group.There were no significant differences on these items between the 2 groups ( P ＞ 0.05 ).Moderate to severe intestinal expansion 1 hour after ERCP was found in 14 patients (26.9％ ) in CO2 group and in 28 patients (56.0％ ) in air group,and the latter was significantly higher than the former (x2 =11.61,P =0.009).Both of the mean abdominal pain and abdominal distention scores at 1 hour post-ERCP in CO2 group were lower than those in air group,but without significant difference (P ＞0.05).However,the mean abdominal pain scores at 2 hours and 6 hours post-ERCP in CO2 group were significantly lower than those of patients in air group (7.4 ±2.2 vs.18.7 ±4.6 at 2 hours post-ERCP,9.6 ±3.7 vs.20.1 ±4.5 at 6 hours post-ERCP,all P ＜ 0.05 ).Similarly,the mean abdominal distention scores at 2 hours and 6 hours post-ERCP in CO2 group were significant lower than those of patients in air group (7.6 ±3.6 vs.18.3 ±4.1 at 2 hours post-ERCP,8.9 ±3.7 vs.19.4 ±4.2 at 6 hours post-ERCP,all P ＜0.05).Conclusion The use of CO2 insufflation instead of air during ERCP appears to be safe.Insufflation of CO2 during ERCP palliates the intestinal expansion,post-ERCP abdominal pain and distention comparison to insufflation of air.However,because of the single-center clinical observation with limited number of cases,the safety and efficacy of CO2insufflation during ERCP requires to be further evaluated.