二氧化碳灌注在结直肠息肉黏膜切除术中的应用  

Clinical study of carbon dioxide insufflation during colorectal polyposis mucosal resection

作　　者：詹磊磊[1] 张侃[1] 蔡任军[1] 刘宇虎[1] ZHAN Lei-lei;ZHANG Kan;CAI Ren-jun;LIU Yu-hu(Dongguan People’s Hospital,523000 Dongguan,Guangdong China)

机构地区：[1]东莞市人民医院,广东东莞523000

出　　处：《临床消化病杂志》2021年第1期22-25,共4页Chinese Journal of Clinical Gastroenterology

基　　金：东莞市社会科技计划发展(一般)项目(No:201950715001870)。

摘　　要：[目的]探讨二氧化碳(CO_(2))作为灌注气体在结直肠息肉黏膜切除术(EMR)中应用的有效性和安全性。[方法]选取本院行结直肠息肉EMR患者84例,采用随机数字法分为空气组(42例)和CO_(2)组(42例),灌注气体分别采用空气和CO_(2),记录每组患者EMR成功率、操作时间及出血、穿孔等并发症;记录术前、术中、术后心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))、经皮CO_(2)分压(PtcCO_(2))的变化;记录术中、结束时、术后1 h、6 h和24 h患者的腹痛程度。[结果](1)空气组与CO_(2)组患者的年龄、性别、BMI、手术成功率、操作时间、肠道评分比较均差异无统计学意义(P>0.05);(2)CO_(2)组术中、结束时、术后1 h、6 h和24 h腹痛评分分别为(41.2±8.3)、(26.8±6.6)、(14.5±5.4)、(4.5±1.2)和(0.7±0.3),明显低于空气组的评分[(56.2±9.3)、(44.7±7.9)、(33.1±6.7)、(10.2±2.5)、(4.8±1.7)],2组比较差异有统计学意义(P<0.05);(3)2组患者术前、术中及术后HR、MAP、SpO_(2)、PtcCO_(2)比较均差异无统计学意义(P>0.05),术中、术后均无出血、穿孔等并发症。[结论]CO_(2)替代空气作为结直肠息肉EMR中的灌注气体安全性高,能明显减轻患者腹部不适感。[Objective]To assess the efficacy and safety of carbon dioxide as insufflation gas in the Colorectal polyposis mucosal resection.[Methods]A total of 84 patients receiving EMR for colorectal polyps in Dongguan people’s hospital were selected and randomly divided into air group(42 cases)and CO_(2) group(42 cases).Air and CO_(2) were used as insufflation gas,and the success rate,operation time,bleeding,perforation and other complications of EMR were recorded in each group.Changes of heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),transcutaneous carbon dioxide resolution partial pressure(PtcCO_(2))in preoperative,intraoperative and postoperative were recorded.The abdominal pain complained by the patients during and 0,1,6,24 hours after the operation were recorded.[Results](1)There was no significant difference in age,gender,BMI,surgical success rate,operation time,intestinal score between the two groups(P>0.05).(2)The abdominal pain score of the CO_(2) group was significantly lower than air group at different time points([41.2±8.3]vs[56.2±9.3],[26.8±6.6]vs[44.7±7.9],[14.5±5.4]vs[33.1±6.7],[4.5±1.2]vs[10.2±2.5],[0.7±0.3]vs[4.8±1.7],P<0.05).(3)There were no significant differences in HR,MAP,SpO_(2) and PtcCO_(2) between the two groups before,during and after operation(P>0.05),the complication of perforation and hemorrhage was not observed in any patient.[Conclusion]CO_(2) can replace air as a safe insufflation gas in EMR for colorectal polyps,and can significantly reduce abdominal discomfort.

关 键 词：结直肠息肉黏膜切除术 二氧化碳 空气 

分 类 号：R656.9[医药卫生—外科学]