灌注液温度对经窦道胆道镜取石患者舒适度及不良反应的随机对照研究

Comparison on comfort and adverse reactions to flush fluid of different temperatures in choledochoscopy via T tube for residual bile duct stones： a prospective randomized controlled trial

摘要:

目的 探讨不同温度灌注液对经窦道胆道镜取石患者疼痛、舒适度及不良反应等的影响。 方法 将经窦道胆道镜取石患者随机分为试验组与对照组，分别用36℃恒温生理盐水与室温生理盐水作为灌注液。记录并分析患者疼痛程度、舒适度、操作时间、灌注液总量、灌注速度及不良反应。 结果 共纳入100例，试验组与对照组各50例。2组在文化程度、工作情况、手术方式及T管直径、是否需碎石、取石时间、灌注液总量及灌注速度方面差异均无统计学意义（P＞0.05）。试验组与对照组胆道镜取石时疼痛评分分别为1.0（1.00，2.00）分与2.0（1.00，3.25）分（Z=-2.158，P=0.031），术中舒适度评分分别为6.0（5.00，7.25）分与5.0（2.00，6.00）分（Z=-3.384，P=0.001），术中术前心率变化率分别为-4.07％±10.76％与0.30％±10.23％（P=0.046），术后腹泻发生率分别为6％（3／50）与22％（11／50）（χ2=5.316，P=0.021）。 结论 36℃恒温生理盐水灌注液可减轻经窦道胆道镜取石患者取石时疼痛感，提高患者舒适度，并能减少术后腹泻发生。

Abstract:

Objective To evaluate effects of flush fluid of different temperatures on pain， comfort and adverse reactions in patients receiving choledochoscopy via T tube for residual bile duct stones. Methods Patients who underwent choledochoscopy were divided into the experimental group （36℃ saline was used as flush fluid） and control group （room temperature saline was used as flush fluid） randomly. Pain degree， comfort degree， procedure time， the total amount of flush fluid， infusion speed and adverse reactions were recorded and analyzed. Results A total of 100 cases were included， 50 cases in each group. There was no significant difference between the two groups in their education level， working condition， operation methods， T-tube size， necessity for lithotripsy， procedure time， total amount of flush fluid and infusion speed （all P＞0.05）. The pain scores were 1.0（1.00, 2.00） and 2.0（1.00, 3.25） （Z=-2.158，P=0.031） and the comfort scores were 6.0（5.00, 7.25） and 5.0（2.00, 6.00） （Z=-3.384，P=0.001） in the experimental group and the control group， respectively. There was significant difference in the change rate of heart rate during and before procedure between the two groups (-4.07％±10.76％ VS 0.30％±10.23％, P=0.046）. The incidence of postoperative diarrhea in the experimental group and the control group was 6％ （3／50） and 22％ （11／50）， respectively （χ2=5.316，P=0.021）. Conclusion 36℃ saline flush can reduce pain scores， improve comfort degree and reduce the incidence of postoperative diarrhea after procedure in patients undergoing choledochoscopy via T tube.