CAJ | 학술논문

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-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CO2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.
목적 탐토ERCP진치과정중CO2대체보통공기경내경주입적안전성화응용개치.방법 102례환자수궤분위CO2주기조(52례)화공기주기조(50례),관찰병발증발생정황급술중생명체정변화정황,대비분석2조술후1h장관확장정도구성정황이급술후1、2、6h복통화복창정도VAS평분결과.결과 2조균순리완성ERCP진료,균미출현ERCP상관병발증,2조술중평균심솔급혈양포화도비교차이무통계학의의(P＞0.05).CO2주기조술후1h중-중도장관확장14례(26.9％),명현저우공기주기조적56.0％ (28/50)(x2=11.61,P=0.009).술후1h복통、복창정도VAS평분CO2주기조균저우공기주기조,단차이균무통계학의의(P＞0.05).CO2주기조술후2h、6h복통정도VAS평분분별위(7.4±2.2)분화(9.6±3.7)분,공기주기조분별위(18.7±4.6)분화(20.1±4.5)분,CO2주기조균명현저우공기주기조(P＜0.05);CO2주기조술후2h、6h복창정도VAS평분분별위(7.6±3.6)분화(8.9±3.7)분,공기주기조분별위(18.3±4.1)분화(19.4±4.2)분,CO2주기조역균명현저우공기주기조(P＜0.05).결론 ERCP진료술중응용CO2대체보통공기주입시안전적,구유교호적림상응용개치.
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.