CAJ | 학술논문

目的：探讨二氧化碳气体（CO2）在内镜黏膜下剥离术（ESD）中的应用价值。方法纳入2012年1月至2014年5月行 ESD 治疗的患者158例，随机分为空气组和 CO2组，对比2组患者在术前、术中和术后动脉血二氧化碳分压（PaCO2）、血氧饱和度（SpO2）监测结果，以及术后腹痛程度和并发症发生情况。结果空气组和 CO2组 ESD 术中 PaCO2[（47．8±5．4）mmHg，（45．1±5．5）mmHg，1 mmHg ＝0．133 kPa]明显高于术前[（37．2±4．6）mmHg，（36．3±3．9）mmHg]（P ＜0．05）和术后[（39．9±4．0）mmHg，（39．4±4．2）mmHg]（P ＜0．05），术前、术中、术后3个时点组间 PaCO2差异不明显（P ＞0．05）；2组术前、术中、术后 SpO2均大于90％，且3个时点组间差异不明显（P ＞0．05）。清醒后2 h 以内（3个观察时点）CO2组腹痛评分均明显低于空气组（P ＜0．05），清醒后12 h 及24 h 腹痛评分组间差异不明显（P ＞0．05）。空气组与 CO2组术中、术后出血率相比差异不明显（P ＞0．05），2组均未出现其它严重并发症。结论CO2在 ESD 治疗中应用安全，并可减少患者术后腹痛，适合在临床推广应用。
목적：탐토이양화탄기체（CO2）재내경점막하박리술（ESD）중적응용개치。방법납입2012년1월지2014년5월행 ESD 치료적환자158례，수궤분위공기조화 CO2조，대비2조환자재술전、술중화술후동맥혈이양화탄분압（PaCO2）、혈양포화도（SpO2）감측결과，이급술후복통정도화병발증발생정황。결과공기조화 CO2조 ESD 술중 PaCO2[（47．8±5．4）mmHg，（45．1±5．5）mmHg，1 mmHg ＝0．133 kPa]명현고우술전[（37．2±4．6）mmHg，（36．3±3．9）mmHg]（P ＜0．05）화술후[（39．9±4．0）mmHg，（39．4±4．2）mmHg]（P ＜0．05），술전、술중、술후3개시점조간 PaCO2차이불명현（P ＞0．05）；2조술전、술중、술후 SpO2균대우90％，차3개시점조간차이불명현（P ＞0．05）。청성후2 h 이내（3개관찰시점）CO2조복통평분균명현저우공기조（P ＜0．05），청성후12 h 급24 h 복통평분조간차이불명현（P ＞0．05）。공기조여 CO2조술중、술후출혈솔상비차이불명현（P ＞0．05），2조균미출현기타엄중병발증。결론CO2재 ESD 치료중응용안전，병가감소환자술후복통，괄합재림상추엄응용。
Objective To explore the value of carbox dioxide(CO2 )for the upper gastrointestinal endoscopic mucosal dissection(ESD).Methods A total of 158 patients who underwent ESD from January 2012 to May 2014 at Endoscopy Center of Dongguan Hospital were enrolled in the study.The patients were randomly divided into air group and CO2 group.The arterial partial pressure of CO2 (PaCO2 ),the monitering results of SpO2 before,during,afte operation,abdominal pain after operation and postoperative complications were assessed.The safety and advantage of CO2 of the upper gastrointestinal ESD were comparative ana-lyzed.Results PaCO2 of air group and CO2 group during the ESD procedures [(47.8 ±5.4)mmHg, (45.1 ±5.5)mmHg]was significantly higher than that before[(37.2 ±4.6)mmHg,(36.3 ±3.9)mmHg] (P <0.05)and after the operation[(39.9 ±4.0)mmHg,(39.4 ±4.2)mmHg](P <0.05).Preoperative, intraoperative and postoperative PaCO2 were not significantly different between the two groups(P >0.05);all the SpO2 were greater than 90%,and it was not significantly different between the two groups(P >0.05). The abdominal pain score of CO2 group was significantly lower than that of air group less than 2 h after wake-up (P <0.05),but there was no difference between the two groups at 12 h and 24 h after operation(P >0.05).The bleeding rate of air group and CO2 group during and after operation was not significantly different (P >0.05),and there were no other serious complications.Conclusion CO2 is safe in the upper gastroin-testinal ESD,and it can reduce postoperative abdominal pain,so it is suitable for clinical application.