二甲硅油的不同配伍方案在胶囊内镜肠道准备中的随机对照研究

Different combinations of dimeticone in intestinal preparation before capsule endoscopy: a randomized controlled study

摘要:

目的 比较二甲硅油与肠道清洁剂的不同配伍方案在胶囊内镜肠道准备中的效果，以探寻最佳的肠道准备方法。方法 将90例拟行胶囊内镜的患者随机分为3组，每组均于检查前4 h常规服用2 L的复方聚乙二醇电解质散导泻清肠。A组（n = 30）检查前30 min口服二甲硅油2.5 g；B组（n = 30）检查前30 min口服二甲硅油5.0 g；C组（n = 30）检查前30 min口服二甲硅油2.5 g，确认胶囊进入小肠后再口服2.5 g。主要评价指标为小肠清洁度和气泡量评分；次要指标为阳性病变诊断率、全小肠检查完成率、胃/小肠通过时间和不良反应发生率。结果 3组患者小肠清洁度比较，差异无统计学意义（P > 0.05）；3组患者小肠上段的气泡量比较，差异无统计学意义（P > 0.05）；当胶囊进入小肠中下段后，B组和C组的气泡量较A组减少（P < 0.05）；且C组的气泡量在小肠下段较B组进一步减少（P < 0.05）；C组阳性病变诊断率较A组和B组高，差异均有统计学意义（P < 0.05）；3组患者全小肠检查完成率、胃/小肠通过时间和不良反应发生率比较，差异均无统计学意义（P > 0.05）。结论 使用二甲硅油5.0 g去泡效果更佳；且在检查前30 min及确定胶囊进入小肠后分次口服较检查前30 min顿服，可增强小肠的去泡效果，改善视野清晰度，提高阳性病变诊断率，值得临床推广。

Abstract:

Objective To compare the intestinal preparation efficacy of the different combinations of dimeticone with an intestinal cleaner in small bowel capsule endoscopy in order to explore the best way.Methods 90 patients underwent capsule endoscopy were randomly divided into three groups, each group was routinely subjected to 2 L polyethylene glycol electrolyte powder in 4 h before the examination. Group A (n = 30): the patients were administered with 2.5 g dimeticone 30 min before the examination; Group B (n = 30): the patients were administered with 5.0 g dimeticone 30 min before examination; Group C (n = 30): the patients were administered with 2.5 g dimeticone 30 min before the examination, and 2.5 g dimeticone was swallowed after the capsule was confirmed to enter the small bowel. Main evaluation indexes: intestinal cleanliness and bubble volume score; Secondary indexes: diagnostic yield, completion rate, passage time of stomach and small bowel, rate of adverse reaction.Results There was no statistically significant difference in intestinal cleanness among the three groups (P > 0.05); There was no statistically significant difference in the number of bubbles of the upper small bowel amomg the three groups (P > 0.05); When the capsule entered the lower segment of the small bowel, the number of bubbles in group B and group C decreased compared with group A (P < 0.05); Moreover, the number of bubbles in the lower segment of the small bowel in group C was further reduced compared with group B (P < 0.05); The difference of diagnostic yield in group C was statistically significant higher than that in group A and B (P > 0.05); There were no significant difference in complete rate, passage time of stomach and small bowel, rate of adverse reaction among the three groups (P > 0.05).Conclusion The anti-foaming effect of 5.0 g dimeticone was better; in addition, it was better to take orally twice 30 min before the examination and after the capsule entering the small bowel than once 30 min before the examination, which can enhance the anti-foaming effect of small bowel, improve the clarity of visual field, and improve diagnostic yield, which is worthy of clinical promotion.