Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography
Patient-controlled room air insufflation versus automated carbon dioxide delivery for CT colonography
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DOI：
10.2214/ajr.05.0416
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发表时间：
2006-06-01
影响因子：
5
通讯作者：
Olsen, CH
中科院分区：
文献类型：
--
作者：
Shinners, TJ;Pickhardt, PJ;Olsen, CH
OBJECTIVE.我们的目的是前瞻性地比较结肠扩张和患者舒适度在筛选CT结肠成像（CTC）与患者控制的室内空气（RA）吹入与自动二氧化碳（CO2）delivery。208名接受CTC的成人被随机分配到RA或CO2组（每种方法104名）。使用4分量表（1 =最佳，2 =充分，3 =不充分，4 =塌陷）按节段前瞻性评估结肠扩张。还记录了仰卧位/俯卧位联合节段性评价的准确性。患者在术前、术中和术后提供0-10量表（0-1 =无/不显著，2-3 =极轻微，4-6 =中度，7-10 =显著）的不适评分。在俯卧位，两种技术之间的节段性扩张没有显著差异。在仰卧位，CO2导致乙状结肠、降结肠和横结肠段显著更大的扩张（p < 0.01）。在仰卧位/俯卧位联合评估后，分别有2/104（1.9%）和3/104（2.9%）例患者被判定为RA和CO2节段评价不充分（4例乙状结肠，1例横断）。检查期间RA和CO2的平均不适评分分别为3.97和5.08（13 < 0.01）;检查后即刻为0.91和0.42（p < 0.01）;检查后15分钟为0.51和0.25（p < 0.05）;检查后2小时为0.15和0.04（p < 0.01）。在主动扩张期间，分别有19例（18.3%）和33例（31.7%）患者报告了RA和CO2的明显一过性不适（p < 0.05）。超过15 min，RA患者中仅有2例（1.9%）不适等级超过3级，CO2组无不适等级超过3级。尽管患者控制的RA吹入和自动CO2输送均导致可忽略的术后不适和可靠的结肠扩张，但CO2对这两种类别均更好。
OBJECTIVE. Our objective was to prospectively compare colonic distention and patient comfort at screening CT colonography (CTC) with patient-controlled room air (RA) insufflation versus automated carbon dioxide (CO2) delivery.SUBJECTS AND METHODS. Two hundred eight adults undergoing CTC were randomized to RA or CO2 (104 per method). Colonic distention was prospectively assessed by segment using a 4-point scale (1 = optimal, 2 = adequate, 3 = inadequate, 4 = collapsed). Adequacy of combined supine/prone segmental evaluation was also recorded. Patients provided discomfort ratings on a 0-10 scale (0-1 = none/insignificant, 2-3 = minimal, 4-6 = intermediate, 7-10 = significant) before, during, and after the procedure.RESULTS. No significant differences in segmental distention were observed in the prone position between techniques. In the supine position, CO2 resulted in significantly greater distention in the sigmoid, descending, and transverse segments (p < 0.01). After combined supine/prone assessment, two/104 (1.9%) and three/104 (2.9%) patients were judged to have an inadequately evaluated segment on RA and CO2, respectively (four sigmoid, one transverse). Mean discomfort scores for RA and CO2 were 3.97 and 5.08 during the examination (13 < 0.01); 0.91 and 0.42 immediately after (p < 0.01); 0.51 and 0.25 15 min later (p < 0.05); and 0.15 and 0.04 2 hours later (p < 0.01), respectively. During active distention, 19 (18.3%) and 33 (31.7%) patients reported significant transient discomfort with RA and CO2 respectively (p < 0.05). Beyond 15 min, only two (1.9%) patients with RA and no patients with CO2 had a discomfort level higher than 3.CONCLUSION. Although patient-controlled RA insufflation and automated CO2 delivery each resulted in negligible postprocedure discomfort and reliable colonic distention, CO2 was better for both categories.