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二氧化碳注入在结肠镜检查中的作用:一项系统回顾和荟萃分析

发布日期:2014-1-29 12:40:35 文章来源:Endoscopy 作者次数:1283
    二氧化碳注入在结肠镜检查中的作用:一项系统回顾和荟萃分析

    J. Wu, B. Hu

    中国上海第二军医大学东方肝胆外科医院内镜组

    背景和研究目的:为提高结肠镜检查期间的可视化程度,有必要对肠道进行充气(通常充入空气)。然而,多数患者抱怨说术后感觉肠道肿胀而且腹痛。因此近来人们一直在使用二氧化碳(CO2)而非空气。我们通过系统回顾与Meta分析所发表的随机对照试验(RCTs),评估结肠镜检查期间注入二氧化碳后的有效性,安全性和舒适感,

    方法:对包括PubMedEMBASECochrane 图书馆,科学引文索引和一些重要的会议摘要在内的数据库进行了检索,并由两名审查者对其进行独立评估。

    结果:对9个随机对照试验研究进行了分析,其中共包括1577例患者。结果发现一些重要结果存在显著异质性;我们采用随机效应模型对这些结果进行了分析。Meta分析显示在手术期间(相对风险度[RR] 0.7795%置信区间[CI] 0.62 - 0.96),以及术后1小时(RR0.2695%CI 0.16 - 0.43),6小时(RR0.3695%CI 0.20 - 0.64)和24小时(RR0.5395%CI 0.31 - 0.91)二氧化碳注入组出现腹痛的患者较少。手术期间需要进行治疗的病人数(NNT)为7例;术后1小时、6小时24小时NNT分别为2312。与空气注入相比,二氧化碳注入会使患者术后肠胃胀气减少,即术后1小时RR 0.0995 %CI 0.03 - 0.24,术后6小时RR 0.3095 %CI 0.14 - 0.62。两组在安全性,气体量和盲肠插管率方面,并无显著差异。

    结论:在结肠镜检查中二氧化碳注入可降低检查期间和术后患者腹部不适,无任何其它不良反应,它适合于临床常规应用。

     

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    The role of carbon dioxide insufflation in colonoscopy: a systematic review and meta-analysis

    J. Wu, B. Hu

    Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China

    Background and study aims: Insufflation of the intestinal tract, usually with room air, is necessary to improve visualization during colonoscopy. However, most patients complain of bowel distension and abdominal pain afterwards. Recently, carbon dioxide (CO2) rather than air insufflation has been used. We aimed to evaluate the efficiency, safety, and comfort of colonoscopy CO2 insufflation, with systematic review and meta-analysis of published randomized controlled trials (RCTs).

    Methods: Databases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index, and important meeting abstracts were searched and evaluated by two reviewers independently.

    Results: Nine RCT studies involving 1577 patients were analyzed. There was significant heterogeneity for some major results; we analyzed these using a random-effects model. Meta-analysis showed fewer patients with abdominal pain in the CO2 group during the procedure (relative risk [RR] 0.77, 95 % confidence intervals [CI] 0.62 - 0.96), and post procedure at 1 hour (0.26, 0.16 - 0.43), 6 hours (0.36, 0.20 - 0.64), and 24 hours (0.53, 0.31 - 0.91). The number needed to treat (NNT) during the procedure was 7; post procedure, the NNT at 1 hour was 2, at 6 hours it was 3, and at 24 hours it was 12. Compared with air, CO2 insufflation was associated with less passage of flatus post procedurally, at 1 hour (RR 0.09, 95 %CI 0.03 - 0.24) and 6 hours (0.30, 0.14 - 0.62). There were no significant differences between the two groups regarding safety, gas volume, and cecal intubation rate.

    Conclusions: Insufflation with CO2 incolonoscopy could decrease abdominal discomfort during and following the procedure, without any additional adverse reactions, warranting routine clinical use.

     

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