胃镜检查前联合应用链霉蛋白酶与西甲硅油的有效性研究

发布时间：2018-06-04 10:27

本文选题：胃镜检查 + 胃黏膜可见度　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的明确胃镜检查前联合应用链霉蛋白酶与西甲硅油的有效性,为胃镜检查前联合使用链霉蛋白酶、西甲硅油的必要性提供有力依据。方法选取2016年4月至2016年12月固原市原州区人民医院655例行胃镜检查的患者,随机分为两组:试验组,检查前20分钟予链霉蛋白霉20000u+1g碳酸氢钠溶于50mL温水联合西甲硅油10mL口服,检查前10分钟予利多卡因胶浆1支含服;对照组,仅检查前10分钟予利多卡因胶浆1支含服。以镜下早期胃癌检出率为研究主要观察终点;患者用药后不适反应发生情况,胃镜下胃黏膜可视度评分、胃镜检查过程中需冲洗次数、操作时间及微小病灶检出情况为次要观察终点。分别统计两组的观察终点指标,通过spss21.0软件进行对比分析。结果本研究共纳入655例胃镜检查患者,有5例因胃潴留、依从性差未完成研究终点指标等原因脱落,最终有650例患者完成本研究,试验组322例,对照组328例。本研究中,试验组患者用药后的不适反应发生情况与对照组无明显差异(P=0.124)。试验组胃黏膜可视度总评分均值为5.72±1.25,对照组胃黏膜可视度总评分均值为6.78±2.25,试验组胃黏膜可视度总评分均值明显低于对照组,即试验组镜下胃黏膜清晰度优于对照组(P0.001)。试验组中,患者胃镜检查过程中有64例需冲洗1-2次,2例需冲洗至少3次,而对照组中分别为173例、35例,在胃镜检查过程中胃黏膜需冲洗的次数明显比试验组多(P0.001)。试验组平均胃镜检查操作时间为176.15±28.92秒,对照组平均胃镜检查操作时间为181.84±50.83秒,试验组平均胃镜检查操作时间与对照组相比无显著差异(P=0.078)。微小病灶中,溃疡、出血点类病灶在试验组中的检出率分别为12.7%、3.1%,在对照组中为7.3%、0.6%,试验组中检出率比对照组中高(P=0.021,P=0.018)。试验组322例病例中,有7例镜下检出且病理明确诊断的早期胃癌病例,对照组无镜下检出且病理明确诊断的早期胃癌病例(P=0.007)。结论胃镜检查前联合使用链霉蛋白酶、西甲硅油对于祛除胃黏膜上的黏液及泡沫,提高胃黏膜视野的可见度有效,有利于对微小病灶及早期胃癌的检出。
[Abstract]:Objective to determine the effectiveness of combined use of strepsin and methylsiloxane oil before gastroscopy, and to provide an effective basis for the necessity of combined use of strepsin and Spanish silicone oil before gastroscopy. Methods from April 2016 to December 2016, 655 patients with gastroscopy in Yuanzhou District people's Hospital of Guyuan City were randomly divided into two groups: experimental group, 20 minutes before examination, 1 g sodium bicarbonate of Streptomyces sp. 20% was dissolved in 50mL warm water combined with 10mL, 10 minutes before examination, 1 dose of lidocaine gel was given, while in control group, only 1 dose of lidocaine gel slurry was given 10 minutes before examination. The detection rate of early gastric cancer under endoscope was taken as the main observation endpoint, the occurrence of uncomfortable reaction after medication, the visual score of gastric mucosa under gastroscope, the times of washing during gastroscopy, The time of operation and the detection of small lesions should be observed at the end point. The endpoints of the two groups were analyzed by spss21.0 software. Results in this study, 655 patients with gastroscopy were included in the study. 5 cases were dropped off due to gastric retention and poor compliance. Finally 650 patients completed the study, 322 cases in the trial group and 328 cases in the control group. In this study, there was no significant difference in the incidence of discomfort between the test group and the control group (P < 0. 124). The mean value of the total visual score of gastric mucosa in the test group was 5.72 卤1.25, and that in the control group was 6.78 卤2.25. The mean value of the total visual degree of the gastric mucosa in the test group was significantly lower than that in the control group, that is, the clarity of gastric mucosa in the experimental group was better than that in the control group under microscope. In the experimental group, 64 cases needed to wash 1-2 times and 2 cases needed to be washed at least 3 times during gastroscopy, while in the control group, 173 cases needed washing at least 3 times, while 35 cases in the control group. In the process of gastroscopy, the frequency of gastric mucosal flushing was obviously more than that of the test group (P 0.001). The mean operating time of gastroscopy was 176.15 卤28.92 seconds in the test group and 181.84 卤50.83 seconds in the control group. There was no significant difference in the mean operating time between the test group and the control group. The detectable rates of small lesions, ulcers and bleeding spots in the experimental group were 12.7and 3.1respectively, and in the control group were 7.30.0.The detection rate in the experimental group was 0.021g / P0. 018m than that in the control group. In the test group, there were 7 cases of early gastric cancer detected under microscope and diagnosed by pathology, while those of control group were not detected under microscope and diagnosed by pathology. Conclusion combined use of strepsin and methylsiloxane oil before gastroscopy is effective in removing mucus and foam in gastric mucosa and improving the visibility of gastric mucosal visual field, which is beneficial to the detection of small lesions and early gastric cancer.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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