N-乙酰半胱氨酸改善上消化道内镜检查图像清晰度的前瞻性随机对照研究  

A randomized controlled trial of improvement of endoscopic visibility in the upper gastrointestinal tract with N-acetylcysteine

作　　者：曹智博[1] 赵治国[1] 崔静[1] 刘超[1] 刘霞[1] 李贵[1] 黄艳玲[1] 弋晓萍[1] 温静[1] 

机构地区：[1]郑州大学第二附属医院消化内科,郑州450014

出　　处：《中华消化内镜杂志》2016年第4期237-241,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨上消化道胃镜检查前应用N．乙酰半胱氨酸（NAC）对术中胃镜图像清晰度的影响及其最佳剂量。方法2014年11月至2015年7月期间，对193例行无痛上消化道胃镜检查的患者进行前瞻性随机双盲对照研究，采用数字表法随机分入5组，术前分别给予100mg二甲硅油＋2gNaHCO，（A组）、100mg二甲硅油＋2gNaHC03＋20000U链霉蛋白酶（B组）、100mg二甲硅油＋2gNaHC03＋200mgNAC（C组）、100mg二甲硅油＋2gNaHC03＋400mgNAC（D组），100mg二甲硅油＋2gNaHCO3＋600mgNAC（E组），均加入100ml生理盐水中口服。胃镜检查由1名固定内镜医师完成，图像清晰度评分由另外2名内镜医师完成，以上3名内镜医师均对分组不知情。统计分析图像清晰度评分总分、内镜操作时冲洗胃腔时间、胃镜检查时间及并发症发生率的组间差异。结果A、B、C、D、E组图像清晰度评分的总分分别为（30．83±3．78）分、（35．69±2．88）分、（33．16±3．90）分、（34．95±3．46）分和（36．76±2．91）分，A组总分最低（P〈0．05），C组其次（P〈0．05），B、D、E组总分均较高且组间差异无统计学意义（P〉0．05），但5组中E组清晰度评分3分的图像最多；胃镜检查过程中需要再冲洗的时间分别为（38．00±19．10）s、（17．03±11．44）s、（15．92±10．81）s、（15．78±10．24）s和（15．55±9．69）s，胃镜检查时间分别为（13．49±2.49）min、（9．41±1．86）min、（9．08±1．80）min、（8．73±1．91）min和（8．78±1．79）min，上述2个指标A组耗时均最长（P〈0．05），而B、C、D、E组同一指标耗时相近（P〉O．05）。各组胃镜检查结束后（患者清醒后）的不适反应总发生率差异均无统计学意义（P〉0．05）。结论术前给予NAC可以明显改善上消化道内镜检查术中的图像质量，以600mg剂量的效果最佳，此剂量的NAC与20000U链霉蛋白酶的效果�Objective To determine the effects and dosage of N-acetylcysteine （NAC） in the im- provement of the visibility in esophagogastroduodenoscopy（EGD）. Methods A prospective randomized con- trolled study was performed on 193 patients scheduled for EGD from November 2014 to July 2015 were ran- domized into five groups using digital table. In group A, 100 mg dimethicone and 2 g NaHCO3 were given. In group B, 100 mg dimethicone, 2 g NaHCO3 and 20 000 U pronase were given. Group C received 100 mg dimethicone, 2 g NaHCO3 and 200 mg NAC. Group D received 100 mg dimethicone, 2 g NaHCO3 and 400 mg NAC and group E 100 mg dimethicone, 2 g NaHCO3 and 600 mg NAC.The agents were dissolved in 100 ml water for each patient.Endoscopy was completed by one endoscopist and the score of image visibility assessment was completed by 2 other endoscopists. The 3 endoscopists were unaware of grouping.The total scores, the time of washing, the time of examination and complications were compared and analysed.Results The total image scores of group A , B, C,DandEwere30.83±3.78, 35.69±2.88, 33.16±3.90, 34. 95±3.46 and 36. 76±2. 91, respectively. Group A was the lowest（P〈0. 05）,followed by group C（P〈 0. 05）. There were no differences among group B,D, and E（P〉0.05）.Images that were scored 3 were the most in group E.The washing times of each group were 38.00±19. 10, 17. 03±11.44, 15.92±10. 81, 15.78 ±10. 24 and 15.55±9.69, and the examination times of each group were 13.49±2.49, 9.41±1.86, 9. 08± 1.80, 8. 73±1.91 and 8.78±1.79 minutes.Group A was the longest in these two indices（P〈0. 05）. There were no significant differences among group B, C, D and E （P〈0. 05）. There were no significant differences in adverse effects among groups after EGD（P〉0. 05）. Conclusion The preoperative NAC can improve the visibility in EGD. The best dose is 600 mg, whose effects and safety were similar to those of 20 000 U, but yield to less washing time and the examination time in EGD.

关 键 词：胃镜检查 乙酰半胱氨酸 链霉蛋白酶 内镜图像质量 

分 类 号：R57[医药卫生—消化系统]