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余少平，东莞康华医院消化科主任，广东省医师协会消化分会常委，广东省中西医结合学会脾胃分会常委，广东省医师协会人文医学分会常委，WJG审稿人之一。从事消化内科专业近30年，分别两次公派到日本、德国进修学习，主攻方向是消化道肿瘤早期防治。在《中华消化杂志》等国内专业杂志发表论文10余篇，在Endoscopy 、JGH 、WJG 、WJGE等杂志发表SCI论文多篇。东莞康华医院消化内科余少平医生评价结肠镜检查过程中应用”拉玛泽肠镜法“进行干预效果的文章《Unsedation colonoscopy can be not that painful: Evaluation of the effect of “Lamaze method of colonoscopy”》去年发表在了2015年10月的《World Journal of Gatrointestinal Endoscopy》杂志上。“拉玛泽减痛分娩法”在50 年代开始到现在一直被应用于妇女自然分娩过程，对减轻产妇自然生产过程中的疼痛起到良好作用；产痛与肠镜检查过程的疼痛机理是相似的，拉玛泽肠镜法就是将其应用到肠镜检查过程，用以减轻肠镜检查疼痛的方法。对比常规麻醉肠镜，患者处于麻醉状态，无疼痛感觉、喉反射消失等，易并发肠出血、肠穿孔以及镇静剂相关的心肺副作用，以及中国麻醉师数量不足、医院设备欠完善、检查费用高等因素，拉玛泽肠镜法对现阶段国内的肠镜检查还是非常有临床应用价值！本研究将585位在该医院进行肠镜的病人，分为拉玛泽肠镜法组、麻醉剂组和对照组进行对比分析。研究结果显示，“拉玛泽肠镜法“在肠镜检查过程中的应用，可以有效减轻病人的疼痛程度且并发症少，有临床应用价值。585例结肠镜检查病人，分为简化拉玛泽减痛法组（拉玛泽组）、麻醉剂组和对照组。拉玛泽组224例在结肠镜检查过程中辅助使用”拉玛泽肠镜法“，麻醉剂组178例接受镇静肠镜，对照组183例则不进行其它干预措施，进行肠镜检查过程中记录肠道清洁度、肠道病变情况、肠镜到达回盲部的时间、成功率、疼痛程度以及并发症，病例资料进行统计学分析。
三组病人肠道清洁度、肠道病变情况、成功率比较均无统计学差异（P>0.05）；麻醉组在到达回盲部的时间优于其他两组（P<0.05）。拉玛泽组到达回盲部时间对比对照组不具优势（p>0.05）。麻醉组在减轻疼痛的表现上很显著（P<><><>1、胸式呼吸：为开始检查时采用，具体：①完全放松。②眼睛注视一定点。③由鼻孔吸气，嘴巴吐气，腹部保持放松。④每分钟6 ～ 9 次吸气及吐气。
2、浅而慢加速呼吸：主要在结肠镜通过降乙交界时采用。方法：①完全放松。②眼睛注视一定点。③由鼻孔吸气，嘴巴吐气。④随疼痛增强而加速呼吸，随疼痛减轻而减缓呼吸。 3、浅呼吸：主要在通过脾曲、肝曲时采用。方法：①完全放松。②眼睛注视一定点。③微张嘴吐气（发出“嘻嘻”的声音），保持高位呼吸，在喉咙处发音。④呼吸速度依疼痛强度调整，吸及吐的气量一样，以免过度换气。⑤连续4 ～ 6 个快速吸吐再大力吐气，重复至疼痛消失结束。
4、闭气用力运动：在感觉到中-重度疼痛时采用。方法：①大力吸气后憋气，往下用力。②尽可能憋气20 ～ 30 s，吐气后马上再憋气用力直至疼痛减轻或消失。Unsedation colonoscopy can be not that painful: Evaluation
of the effect of “Lamaze method of colonoscopy”
To evaluate the pain relieving effect of intervention with “Lamaze method of colonoscopy” in the process of colonoscopy.
585 patients underwent colonoscopy were randomly divided into three groups, Lamaze group, anesthetic group and control group. 224 patients of Lamaze group, the “Lamaze method of colonoscopy” were practiced in the process of colonoscopy. The Lamaze method of colonoscopy is modified from the Lamaze method of childbirth, which helped patients to relieve pain through effective breathing control. 178 patients in anesthetic group accepted sedation colonoscopy. For 183 patients in control group, colonoscopy was performed without any intervention. The satisfactory of colon cleaning, intestinal lesions, intubation time, success ratio, pain grading and complications were recorded. All data were statistically analyzed.
There were no significant differences at base line of the three groups (P > 0.05). Anesthetic group shows advantage in intubation time than the other two groups (P < 0.05).="" lamaze="" group="" shows="" no="">in intubation time than that in control group (P > 0.05). The anesthetic group showed an apparent advantagein relieving pain (P < 0.01).="" therefore,="" the="">method of colonoscopy” performed in colonoscopy could relieve pain effectively comparing with control group (P < 0.05).="" the="" patients="" in="" anesthetic="" group="">the highest incidence of complications (P <>
The performance of the “Lamaze method of colonoscopy” in the process of colonoscopy could relieve patients’ pain, minimize the incidence of complications, and is worthy promotion in clinical practice.
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