链霉蛋白酶+西甲硅油对无痛胃镜检查效果的影响

Impact of pronase+simethicone on painless gastroscopy

摘要:

目的 探讨链霉蛋白酶+西甲硅油在无痛胃镜患者检查前不同时间口服及服用后体位不同对检查效果的影响。方法 选择杭州市第一人民医院门诊及住院接受无痛胃镜检查的患者740例，随机分成链霉蛋白酶+西甲硅油组（n = 300）、西甲硅油组（n = 240）和对照组（盐酸利多卡因胶浆组，n = 200）。观察并对比3组患者在无痛胃镜检查前5、10、15、20、25、30、45和60 min口服上述药物及服药后患者采取不同体位［坐位、立位（间断行走）和卧位（间断左右侧身）］的胃镜视野清晰度、丙泊酚使用剂量、胃镜操作时间、恶心呕吐发生率、癌前病变和早期胃癌检出率。结果 链霉蛋白酶+西甲硅油组的胃镜视野清晰度、丙泊酚使用剂量、内镜操作时间和癌前病变及早期胃癌检出率明显优于西甲硅油组和对照组（P < 0.01），而西甲硅油组又优于对照组（P < 0.01）；3组患者的恶心呕吐发生率比较，差异无统计学意义（P > 0.05）。链霉蛋白酶+西甲硅油组在无痛胃镜检查前20和25 min口服链霉蛋白酶+西甲硅油后，胃镜视野清晰度更佳（P < 0.05），但这两者间比较，差异无统计学意义（P > 0.05）。链霉蛋白酶+西甲硅油组采取立位（间断行走）和卧位（间断左右侧身）的胃镜视野清晰度优于坐位，差异有统计学意义（χ²₁ = 14.56，P₁ = 0.000；χ²₂ = 16.61，P₂ = 0.000）；采取立位（间断行走）和卧位（间断左右侧身）的胃镜视野清晰度比较，差异无统计学意义（χ²₃ = 0.12，P₃ = 0.733）。结论 无痛胃镜检查前应用链霉蛋白酶+西甲硅油可有效提高胃镜视野清晰度、缩短内镜操作时间、减少丙泊酚使用剂量、提高癌前病变及早期胃癌检出率；胃镜前20和25 min服药及服药后采取立位（间断行走）及卧位（间断左右侧身）效果更佳。

Abstract:

Objective To investigate the effect of pronase + simethicone taking at different times before painless gastroscopy and patient’s different position after taking they on gastroscopy.Methods The patients who received painless gastroscopy were randomly divided into the pronase + simethicone group (n = 300), the simethicone group (n = 240), and the control group (lidocaine hydrochloride glue group, n = 200). The endoscopic visual field clarity, the propofol dosage, the endoscopic operation time, the incidence of nausea and vomiting, the detection rate of precancerous lesions and early gastric cancer were observed and compared among the three groups of patients taking the above drugs 5, 10, 15, 20, 25, 30, 45, and 60 min before the painless endoscopy and taking different positions [sitting, standing (intermittent walking) and lying down (intermittent left and right sideways) after taking the drugs].Results The endoscopic visual field clarity, the dosage of propofol, the endoscopy operation time and the detection rate of precancerous lesions and early gastric cancer in the pronase + simethicone group were significantly better than those in the simethicone group and the control group (P < 0.01), the simethicone group was better than that in the control group (P < 0.01); There was no significant difference in the incidence of nausea and vomiting among the three groups (P > 0.05). In the pronase + simethicone group, the clarity of the gastroscope visual field was better after oral administration 20 and 25 min before painless gastroscopy (P < 0.05), but there were no statistically significant difference between the two groups (P > 0.05). In the pronase+simethicone group, the endoscopic visual field clarity in those taking the standing position (intermittent walking) or lying position (intermittent left and right sideways) was better than those taking the sitting position, and the difference were statistically significant (χ²₁ = 14.56, P₁ = 0.000; χ²₂ = 16.61, P₂ = 0.000); There was no obvious difference in the endoscopic visual field clarity between those taking the standing position (intermittent walking) and the lying position (intermittent left and right sideways) (χ²₃ = 0.12, P₃ = 0.733).Conclusion The application of pronase and simethicone before painless gastroscopy can effectively improve the clarity of the gastroscope’s visual field, shorten the endoscopy operation time, reduce the dosage of propofol, and increase the detection rate of precancerous lesions and early gastric cancer; The result was better in those taking the medicine 20 and 25 min before gastroscopy and taking the standing position (intermittently walking) and lying position (intermittently walking sideways).