Kolonoskopi sirasinda spazmolitik uygulamasi yararli midir?
Is there any beneficial effect of a spasmolytic agent during colonoscopy?
Özet
Giris ve amaç: Kolondaki spazm kolonoskopi islemini güçlestirmekte, hasta için agrili olup hasta toleransini azaltmaktadir. Bu çalismanin amaci spazmi ortadan kaldirabilecek bir spazmolitik ajanin (Hyoscine- N-butyl bromide) uygulamasinin kolonoskopi islemine katkisini arastirmaktir. Gereç ve yöntem: Ikibin yilinin Mart-Nisan aylari içinde kolonoskopi ünitesine çesitli nedenlerle basvuran ardisik 89 hasta çalismaya alindi. Hastalar rastlantisal olarak iki gruba ayrildi ve bir gruba spazmolitik olarak Hyoscine-N-butyl bromide 10 mg intravenöz olarak uygulanirken diger gruba hiç bir ilaç verilmedi. Ayrica hiç bir hastaya sedasyon uygulanmadi. Isleme baslamadan önce ve islem bittikten hemen sonra kan basinci ve nabiz dakika sayisi ölçüldü ve kaydedildi. Islem süresince kolonun kirliligi 0-4 arasi, spastisite 0-100 arasi ve zorluluk 0-4 arasi skorlandi. Isleme baslama zamani, çekuma ulasma zamani ve islem bitis zamani kaydedildi. Bulgular: Çalismaya alinan 89 hastanin 38’i kadin olup yas ortalamalari 46,86±14,74 idi. Ellibir hasta ise erkek olup yas ortalamalari 48,50±14,37 idi. Hastalarin 44 tanesine hiçbir medikasyon yapilmazken, 45 hastaya Hyoscine-Nbutyl bromide 10mg intravenöz olarak uygulandi. Çalismada antispazmodik uygulanan grupta çekuma ulasma zamaninin istatistiksel olarak anlamli olmasa da (p=0.071) daha uzun oldugu gözlendi. Islem bitiminde kan basincindaki artisin erkeklerde baslangica göre anlamli düzeyde oldugu gözlendi (p=0.049). Islem sonunda diyastolik kan basincindaki artis ileri yasla birlikte belirginlesiyordu (p=0.001), nabiz dakika sayisindaki artis kadinlarda erkeklerden daha belirgindi (p=0.01). Sonuç: Spazmolitik ajan kullaniminin kolonoskopide herhangi bir yararinin olmadigini aksine çekuma ulasma zamanini etkileyebilecegi bulundu.
Abstract
Background and aim: Colonic spasm is a complication of colonoscopy which may cause pain and intolerance of the procedure. The aim of this study was to evaluate the benefit of a spasmolytic agent used for colonic spasm. Meterial and methods: Eighty-nine consecutive patients referred for colonoscopy between March and April 2000 were included in the study. They were divided into two groups randomly, with the first group receiving Hyoscine-N-Butyl Bromide (10 mg intraveneously) as a spasmolytic agent and the second group no drugs. No sedation was given to any patient. The blood pressure and pulse rate of each patient was recorded before and immediately after the procedure. Bowel preparation was scored between 0 and 4, spasticity between 0 and 100, and diffuculty of procedure between 0 and 4. The time of starting the procedure reaching to caecum and finishing were recorded. Age, ,bowel preparation score, spasticity score, caecum time, systolic and diastolic blood pressures and pulse rate before and after the procedure were compared between the two groups. Result: The 89 patients comprised 51 males (mean age 48.50±14.37 years) and 38 females (mean age 46.86±14.74 yeras). The first group receiving N-Hyoscine-Butyl- Bromide consisted of 45 patients and the second group 44 patients. Although statistically insignificant, the time taken to reach the caecum (caecum time) was longer in the first group (p=0.071). Increase in blood pressure was more significant in male patients (p=0.049), with diastolic blood pressure increasing according to age (p=0.001). The pulse rate was higher in females patients (p=0.01) Conclusion: Hyoscine-N Bromide was found to be ineffective as a spasmolytic agent during colonoscopy and to possibly have a negative effect on the time taken to reach the caecum.
