胃镜检查前口服不同剂量西甲硅油的临床价值比较

摘要

Objective We aimed to evaluate the antifoaming effect of different doses of simethicone administered orally before gastroscopy, in order to find a dose with better effect. Methods Four hundred and forty-one patients underwent thorough gastroscopic examination in Guangdong General Hospital (Guangdong Academy of Medical Sciences) were recruited from April to May, 2014. All cases were randomly divided into control group (n=90), simethicone 100 mg group (n=60), simethicone 200 mg group (n=62), simethicone 400 mg group (n=167), simethicone 600 mg group (n=62), and received oral administration of 0, 100, 200, 400, 600 mg simethicone, respectively at 30 minutes before gastroscopy. The primary indicators for evaluating the antifoaming effect of simethicone were mucosal visibility grade, duration of gastroscopy , endoscopic physician's satisfaction with the process of gastroscopy and patient's tolerance of gastroscopy . Results The proportion of patients with grade A of gastric mucosal visibility for control group, simethicone 100 mg group, simethicone 200 mg group, simethicone 400 mg group, simethicone 600 mg group was 11.1%(10/90), 40.0%(24/60), 83.9%(52/62), 97.6%(163/167), 98.4%(61/62), respectively, indicating that the gastric mucosal visibility increased with the increase in the dose of simethicone used before gastroscopy(rs=0.722,P<0.001). Simethicone 400 mg group and simethicone 600 mg group demonstrated much shorter duration of gastroscopy compared with the control group (P<0.05). The endoscopic physician's satisfaction level with the process of gastroscopy was much lower in the control group compared with other groups (P<0.001). Besides, all cases could endure gastroscopy and no one complained obvious discomfort. Conclusion Oral administration of simethicone before gastroscopy,even with a dose of 100 mg, could improve the gastric mucosal visibility and shorten the duration of gastroscopy. Moreover, gastric mucosal visibility would be increased with the increase in the dose of simethicone. In view of the benefit and cost, 400 mg simethicone is suggested to be used clinically.%目的 评价胃镜检查前口服不同剂量西甲硅油的祛泡效果,明确有效的给药剂量.方法 收集2014年4-5月在广东省人民医院接受胃镜检查的患者441例,随机分为对照组(90例)、西甲硅油100 mg组(60例)、西甲硅油200 mg组(62例)、西甲硅油400 mg组(167例)、西甲硅油600 mg组(62例).分别于胃镜检查前30 min口服西甲硅油0、100、200、400、600 mg.主要评价指标包括黏膜可视度、胃镜检查时间、操作者的满意度和患者耐受情况.结果 对照组、西甲硅油100 mg组、西甲硅油200 mg组、西甲硅油400 mg组、西甲硅油600 mg组黏膜可视度达A级者分别为11.1%(10/90)、40.0%(24/60)、83.9%(52/62)、97.6%(163/167)、98.4%(61/62).西甲硅油剂量与黏膜可视度呈正相关(rs=0.722,P<0.001).西甲硅油400 mg组、600 mg组胃镜检查时间短于对照组(P<0.05).操作者对西甲硅油各组的满意度高于对照组(P<0.001).患者均能耐受胃镜检查,且无明显不适.结论 胃镜检查前口服西甲硅油,可显著提高镜下黏膜可视度、缩短检查时间.100 mg西甲硅油即能改善镜下黏膜可视度,剂量越大效果越好,但结合临床获益和经济成本推荐使用400 mg西甲硅油.