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结肠镜检查后失禁:一个未被认识到且可以预防的问题

发布日期:2014-1-29 12:40:36 文章来源:Endoscopy 作者次数:1207
    背景:结肠镜检查为了观察肠道情况需要注入气体,通常使用空气,本研究的目的就是评估结肠镜检查后大小便失禁的风险,并研究使用CO2代替空气能否减少这种风险,因为CO2更易被肠粘膜吸收。
    方法:这是一项多中心的前瞻性研究,2009年1月到12月,通过挪威国家质控系统收集到21个内镜中心的连续病例,共7812例18岁以上患者进行门诊肠镜检查,其中5015例注入空气,2797例注入CO2
    结果:采用二元逻辑回归分析比较不同充气模式下结肠镜检查后出现持续24h大小便失禁的情况,空气组和CO2组两组的年龄、性别、内镜指征、麻醉方式具有可比性。7812例患者共出现336例失禁情况(4.3%),失禁发生率CO2组明显低于空气组(2.1 % 比5.5 %; OR= 0.38; 95 %CI 0.28 ~0.50; P < 0.001),女性病人发生失禁的风险高于男性(OR=1.77; 95 % CI 1.39~2.24; P < 0.001)。
    结论:大约每20例采用空气注入的肠镜检查患者就有1例出现失禁情况,如果采用CO2代替空气注入进行肠镜检查可减少60%的失禁风险。

    Incontinence after colonoscopy - an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program
     
    G. Hoff1, 2, 3, V. Moritz1, M. Bretthauer2, L. Aabakken4, I. P. Berset5, T. Glomsaker6, O. Høie7, T. de Lange8, on behalf of the Gastronet collaborators
    1Department of Medicine, Telemark Hospital, 3710 Skien, Norway
    2Cancer Registry of Norway, 0304 Oslo, Norway
    3University of Oslo, 0027 Oslo, Norway
    4Department of Medicine, Rikshospitalet, University of Oslo, 0027 Oslo, Norway
    5Department of Medicine, Aalesund Hospital, 6022 Aalesund, Norway
    6Department of Surgery, Stavanger University Hospital, 4068 Stavanger, Norway
    7Department of Medicine, Sørlandet Hospital Arendal, 4809 Arendal, Norway
    8Department of Medicine, Bærum Hospital Vestre Viken HF, 1309 Rud, Norway
     

    Background: Colonoscopy requires insufflation of gas for visualization of the bowel wall. Worldwide, this is usually done using air. The aim of the present study was to assess the risk of postcolonoscopy incontinence, and to investigate whether insufflation of CO2 instead of air may reduce this risk, since it is easily absorbed through the bowel mucosa.

    Methods: This is a prospective multicenter study of colonoscopy patients undergoing bowel insufflation using air or CO2. A successive series of colonoscopies were reported to a national quality assurance program in Norway between January and December 2009 from 21 endoscopy centers with varying insufflation practices. The study comprised 7812 patients aged 18 years or older who were referred for outpatient colonoscopy. Of these, 5015 underwent colonoscopy performed using air and 2797 colonoscopy using CO2 insufflation.

    Results: Patient-reported incontinence up to 24 h after colonoscopy was compared using binary logistic regression analysis for the type of gas used for insufflation. The air and CO2 patient groups were comparable with regard to age, sex, indication for colonoscopy, and sedation practice. Incontinence was reported by 336 out of 7812 patients (4.3 %). Incontinence was significantly less frequent in the CO2 group than in the air group [2.1 % versus 5.5 %; adjusted odds ratio (OR) 0.38; 95 %CI 0.28 - 0.50; P < 0.001]. Female patients had a higher risk of incontinence than men (adjusted OR 1.77; 95 % CI 1.39 - 2.24; P < 0.001).

    Conclusion: About every 20th patient undergoing colonoscopy using standard air insufflation experiences postexamination incontinence. This proportion can be reduced by 60 % by converting from air insufflation to insufflation with the absorbable CO2.

    Publication Date: 05 March 2012
     

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