山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (10): 38-45.doi: 10.6040/j.issn.1671-7554.0.2023.0206
李然1,2,郭安兵1,张秀云1,鲁临1,杜超1,2
LI Ran1,2, GUO Anbing1, ZHANG Xiuyun1, LU Lin1, DU Chao1,2
摘要: 目的 验证行胃镜检查前服用配制的碳酸氢钠溶液可达到与现临床常用祛泡药物大体相当的祛泡效果,且不影响镜下病变的发现率。 方法 本研究是一项双盲、单中心、随机对照试验,共纳入950例行胃镜检查的患者,被随机分配到6组,设定A组、B组、C组为试验组,D组、E组、F组为对照组:A组:1 g碳酸氢钠散融入50 mL 40 ℃温开水;B组:2 g碳酸氢钠散融入50 mL 40 ℃温开水;C组:1 g碳酸氢钠散+3 mL西甲硅油乳剂融入50 mL 40 ℃温开水;D组:20 000 U链霉蛋白酶颗粒(含1 g碳酸氢钠散)+3 mL西甲硅油乳剂融入50 mL 40 ℃温开水(本中心固定胃镜前准备用药);E组:含1.2 g乙酰半胱氨酸+3 mL西甲硅油乳剂融入50 mL 40 ℃温开水;F组:50 mL 40 ℃温开水。术前5 min均常规饮用10 mL盐酸利多卡因胃镜润滑剂麻醉咽喉部,检查完成后由操镜医师填写黏膜清晰度、医师操作满意度评分表,同时记录内镜下诊断,计算总黏膜清晰度评分。 结果 饮用温开水的F组祛泡效果最差,整体黏膜清晰度评分达到5分者仅占2%,达到医师满意者仅为71%,明显低于其他5组。各部位评分及医师操作满意度差异与其他5组相比均有统计学意义(P<0.003)。D组总黏膜清晰度评分达5分占比70%,医师操作满意占比98%,祛泡效果最佳;A组与D组相比,仅总黏膜清晰度评分差异有统计学意义(P<0.003),其他部位评分及医师操作满意度差异均无统计学意义,祛泡效果A组和D组大致相当;A组与C组相比,胃底评分差异有统计学意义(P<0.003),其他部位评分及医师操作满意度差异无统计学意义;C组与D组相比,胃底、胃体、总黏膜清晰度评分差异均有统计学意义(P<0.003),C组总体祛泡效果尚可;A组与B组相比,各部位评分及医师操作满意度差异均有统计学意义(P<0.003),祛泡效果A组明显优于B组;E组与A、C两组相比,各部位评分和医师操作满意度差异均无统计学意义,祛泡效果大致相同;6组镜下病变发现率差异均无统计学意义(P>0.003)。 结论 胃镜检查前服用1 g碳酸氢钠配制的溶液可达到与临床常用祛泡药物大体相当的祛泡效果,且不影响镜下病变发现率。1 g碳酸氢钠祛泡效果优于2 g碳酸氢钠,添加西甲硅油可能无法获得更好成效。碳酸氢钠价格低廉,值得基层医院推广。
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