氢溴酸东莨菪碱在探头式共聚焦胃镜检查中的临床应用分析

发布时间：2018-01-17 20:39

本文关键词：氢溴酸东莨菪碱在探头式共聚焦胃镜检查中的临床应用分析　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景及目的：共聚焦激光显微内镜(CLE)是目前唯一能够达到活体组织病理学水平的内镜技术,这种放大1000倍的图像可清晰辨认组织结构、细胞及亚细胞结构,即时准确的做出高分辨率的组织学诊断,并及时采取相应治疗措施,避免重复内镜检查和多次活检并发症的发生。氢溴酸东莨菪碱为M胆碱受体阻滞药,因其抗胆碱作用临床上已被广泛用于胃、十二指肠、结肠的纤维内镜检查的术前准备。目前该药在普通胃镜操作中的作用已得到证实,既可以减轻患者的痛苦,又能有效的提高胃镜检查的质量。然而在共聚焦激光显微胃镜检查术中,解痉药应用的有效性并未得到证实。本试验旨在研究氢溴酸东莨菪碱应用于探头式共聚焦激光显微胃镜(pCLE)检查术中的有效性与安全性。研究方法：自2014年8月至2015年2月,,将山东大学齐鲁医院胃镜室行探头式共聚焦激光显微胃镜检查术的门诊患者(年龄为18-80岁且无氢溴酸东莨菪碱应用禁忌者)随机分为A、B两组,A组给与氢溴酸东莨菪碱0.3mg (1l)肌注,B组给与等量生理盐水(1m1)肌注。操作中共聚焦激光显微内镜探头探视病变部位及胃镜检查五个标准部位(胃窦大弯、小弯侧,胃体大弯、小弯侧,胃角)的共聚焦图像并进行图像实时评分,于可疑部位取病理送检,记录胃镜操作时间及不良反应发生次数,统计两组患者病变检出率,对于取病理患者,以病理诊断为金标准统计两组胃镜诊断准确程度。比较两组患者以上各项指标的差异。研究结果：本研究共纳入患者122例,其中剔除6例,最终116例患者数据资料录入分析。结果示两组患者在性别组成、平均年龄、身高、体重、病变检出率、诊断准确率、不良事件发生率方面,A、B两组差异无统计学意义；在胃镜检查五个标准部位(胃窦大弯、小弯侧,胃体大弯、小弯侧,胃角)及病变部位的共聚焦图像评分中,两组胃窦大弯侧、胃体大弯侧图像评分无统计学意义(X2=0.057,P=0.811；X2=2.939,P=0.086),而对于胃窦小弯侧,胃体小弯侧、胃角部及病变部位的共聚焦图像评分,A组图像质量明显高于B组,且有统计学意义(X2=9.046,P=0.005；X2=4.417,P=0.036；X2=9.979,P=0.004；X2=8.849, P=0.006):与B组相比,A组胃镜操作时间明显缩短(t=2.075,P=0.04)。结论：在探头式共聚焦激光显微胃镜检查中,应用氢溴酸东莨菪碱能有助于得到较高质量的共聚焦图像,且有效缩短胃镜检查时间。
[Abstract]:Background and objective: confocal laser microendoscopy (CLEs) is the only endoscopic technique capable of achieving the level of histopathology in vivo at present. Cell and subcellular structure, the immediate and accurate high-resolution histological diagnosis, and timely take appropriate treatment measures. To avoid repeated endoscopic examination and multiple biopsy complications. Scopolamine hydrobromide is a M-choline receptor blocker, because of its anticholine effect clinical has been widely used in the stomach and duodenum. Preoperative preparation for fibroendoscopy of colon. The role of the drug in general gastroscopy has been confirmed, which can alleviate the pain of patients. It can also effectively improve the quality of gastroscopy. However, in confocal laser microgastroscopy. The efficacy of antispasmodic was not confirmed. The purpose of this study was to study the application of scopolamine hydrobromide to probe confocal laser microgastroscopy (pCLEs). Effectiveness and safety of intraoperative examination. Methods: from August 2014 to February 2015. , the outpatients (aged 18-80 years with no contraindication of scopolamine hydrobromide) who underwent confocal laser microgastroscopy in the gastroscope room of Qilu Hospital of Shandong University were randomly divided into two groups. Group A was given scopolamine hydrobromide 0.3mg / l intramuscularly. Group B was given the same amount of normal saline (1ml) intramuscularly. The lesion site was visited by confocal laser microendoscopic probe and the five standard sites (great antral curvature, small curvature side, great curvature of gastric body, small curvature side) were examined by gastroscopy. The confocal image of gastric angle) was evaluated in real time. Pathological examination was performed at the suspected site. The operating time of gastroscope and the occurrence times of adverse reactions were recorded. The detection rate of pathological changes in the two groups was counted and the pathological patients were taken. The accuracy of gastroscope diagnosis in the two groups was calculated by using pathological diagnosis as gold standard. The differences of above indexes between the two groups were compared. Results: 122 patients were included in this study, 6 of them were excluded. The results showed that the sex composition, average age, height, weight, detection rate of pathological changes, diagnostic accuracy and incidence of adverse events in the two groups were significantly higher than those in the control group. There was no significant difference between the two groups. In gastroscopy examination of the five standard sites (great antral curvature, small curvature, great curvature of the body, small curvature, gastric angle) and the lesions of the confocal image score, two groups of the great curvature of the antrum. There was no statistical significance in the image score of the great flexural side of the stomach. The quality of confocal images in group A was significantly higher than that in group B for the lesser curvature of the antrum, the lesser curvature of the body of the stomach, the corner of the stomach and the location of the lesion. And there was statistical significance in X2P0. 046 and P0. 005; X2, 4.417, P0. 036; X2, 9.979, P0. 004; Compared with group B, the operation time of gastroscope in group A was significantly shorter than that in group B (8.849, P < 0.006). Conclusion: scopolamine hydrobromide can help to obtain high quality confocal image and shorten the time of endoscopy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R573

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