西甲硅油联合不同剂量碳酸氢钠改善上消化道内镜图像清晰度的研究

Simethicone combined with different doses of sodium bicarbonate to improve the image clarity of upper gastrointestinal endoscopy

摘要:

目的 通过对西甲硅油加入不同剂量的碳酸氢钠，评估不同配比对提高胃镜检查图像清晰度影响。方法 选取首都医科大学附属北京友谊医院2024年11月至12月间，接受普通胃镜检查的患者共120例，进行前瞻性随机双盲对照研究。采用数字表法，将患者随机平均分入4组，每组30例。胃镜前分别给予400 mg西甲硅油（A组）、400 mg西甲硅油+1.0 g碳酸氢钠（B组）、400 mg西甲硅油＋1.6 g碳酸氢钠（C组）、400 mg西甲硅油＋2.0 g碳酸氢钠（D组）。比较4组患者胃镜检查视野清晰度、检查时间及不良反应。结果 胃镜视野清晰度达到优的总例数，A组4例（13.3%）、B组10例（33.3%）、C组13例（43.3%）、D组18例（60.0%）。D组患者胃镜视野清晰度为优的比例明显高于A组，D组中患者胃镜视野清晰度为良的比例明显低于A组，差异有统计学意义（X2≈17.7，P<0.05）。4组在胃镜检查时间方面差异无统计学意义[（412±46）s、（402±53）s、（398±47）s、（392±36）s,F=1.01，P>0.05]，且均未发生严重不良反应。结论 在胃镜检查前口服西甲硅油乳剂可加入碳酸氢钠防止絮凝发生，随着碳酸氢钠的剂量逐渐增加，胃黏膜清晰度有逐渐增高趋势。口服西甲硅油400 mg联合2.0 g碳酸氢钠可获得更好的内镜图像清晰度。

Abstract:

Objective To evaluate the effect of different ratios of simethicone combined with various doses of sodium bicarbonate on improving image clarity during gastroscopy.Methods A prospective, randomized, double-blind controlled study was conducted on 120 patients undergoing routine gastroscopy at Beijing Friendship Hospital, Capital Medical University from November to December 2024. Patients were randomly assigned to 4 groups (n=30 each) using a random number table. Before gastroscopy, patients received 400 mg simethicone alone (Group A), 400 mg simethicone plus 1.0 g sodium bicarbonate (Group B), 400 mg simethicone plus 1.6 g sodium bicarbonate (Group C), and 400 mg simethicone plus 2.0 g sodium bicarbonate (Group D), respectively. Visual field clarity, examination duration, and adverse reactions were compared among the four groups.Results The number of patients with excellent visual field clarity was 4 (13.3%) in Group A, 10 (33.3%) in Group B, 13 (43.3%) in Group C, and 18 (60.0%) in Group D. The proportion of patients with excellent visual field clarity was significantly higher, and the proportion with good clarity was significantly lower in Group D than in Group A (χ2≈17.7, P<0.05). No significant difference was found in gastroscopy duration among the four groups [(412±46) s, (402±53) s, (398±47) s, (392±36) s; F=1.01, P>0.05]. No severe adverse reactions occurred in any group.Conclusion Oral simethicone emulsion combined with sodium bicarbonate before gastroscopy can prevent flocculation. Gastric mucosal clarity tends to improve gradually with increasing sodium bicarbonate dose. Oral administration of 400 mg simethicone plus 2.0 g sodium bicarbonate achieves superior endoscopic image clarity.