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。

Safety and comfort of colonoscopy with carbon dioxide insufflation in elderly people

Objective To assess the safety and comfort of colonoscopy with carbon dioxide（CO2） insufflation in elderly people. Methods This was a randomized controlled double-blind study. Totally 110 consecutive elderly participants undergoing colonoscopy were randomized into air insuffiation group（n=55） and CO2 insuffiation group（n=55）. Patients＇ experiences of abdominal pain and bloat were registered using Visual Analog Scale （VAS）. The degrees of pneumatosis in the intestinal canal were recorded by the X-ray exam. Transcutaneous partial CO： pressure was continuously measured with a capnograph as a safety parameter. Above parameters were compared between air insuffiation and CO2 insuffiation group. Results VAS scores and pneumatosis scores in CO2 group were significantly lower than those in air group （7.0 ± 4.9） vs （9.0 ± 3.7） min; P 〈 0.05] during and after examination. The questionnaire survey of abdominal pain and bloat at different time points （5, 10, 15, 20 min after colonoseopy） showed that the questionnaire score in CO2 group were significantly lower than that in air group 5min： （15.4 ± 2.1） vs （63.5 ± 13.5）; 10min： （5.1 ± 1.3） vs （60.3 ± 10.9）; 15rain： （0.5 ± 0.7） vs （58.6 ± 11.6）; 20min： （0.0 ± 0.7） vs （50.4 ± 8.2）; P 〈 0.01]. The intestinal dilatation scores were significantly lower in CO2 group compared With that in air group （1.2 ± 0.5） vs （3.6 ± 0.9）; P 〈 0.05]. No significant changes of end-tidal CO2 pressure were found between CO2 and air groups. Conclusion Compared with air insuffiation, colonoscopy with CO2 insufflation has the same safety and reliability. Furthermore, colonoscopy with CO2 insuffiation possesses the significant advantages of less abdominal pain, shorter examination time and better toleration in elderly patients.