甲氧氯普胺对胶囊内镜胃内滞留的影响

Effect of metoclopramide on gastric retention of capsule enteroscope

目的探讨甲氧氯普胺对胶囊内镜胃内滞留的影响,以期为临床解决胶囊内镜胃内滞留提供方法。方法前瞻性纳入2012年7月—2015年7月在南通大学附属医院消化内科行胶囊内镜检查的患者60例,按随机数字表将患者分入干预组和对照组,每组30例。干预组患者在口服胶囊内镜后立即予肌内注射甲氧氯普胺10mg,对照组不予任何干预。主要观察指标为胃内滞留率(胶囊内镜在胃内运行时间≥1h定义为胃内滞留),次要观察指标为胃、小肠通过时间和全小肠检查完成率。干预组检查结束后观察患者是否出现甲氧氯普胺的不良反应。结果 60例患者中55例胶囊内镜顺利通过胃进入十二指肠,4例患者(均为对照组患者)胃内滞留,1例患者(干预组患者)因无法吞咽胶囊内镜需使用胃镜和圈套器将其送入十二指肠而未纳入胃内滞留率的计算,总体胃内滞留率为6.78%(4/59),干预组的胃内滞留率为0,显著低于对照组的13.33%(χ2=4.148,P=0.042)。干预组中1例因无法吞咽胶囊内镜需由胃镜送入十二指肠和1例因小肠多发溃疡狭窄导致胶囊内镜滞留后行手术治疗的患者未纳入数据分析。纳入数据分析的58例患者中,56例完成了全小肠检查(干预组和对照组中各有1例胶囊内镜在工作时间内未进入盲肠),总完成率为96.55%(56/58),干预组全小肠检查完成率为96.43%(27/28),对照组为96.67%(29/30),两组间差异无统计学意义(P>0.05)。干预组中1例因无法吞咽胶囊内镜而由胃镜送入十二指肠的患者未纳入胃通过时间的统计,未完成全小肠检查的3例患者未纳入小肠通过时间的统计;对照组有4例患者胶囊内镜胃内滞留,1例患者胶囊内镜在工作时间内未进入盲肠,未纳入胃和小肠通过时间的统计。干预组的平均胃通过时间为(22.07±15.78)min,对照组为(22.27±13.58)min;干预组的平均小肠通过时间为(329.54±190.68)min,对照组为(327.00±186.87)min。两组间胃和小肠通过时间的差异均无统计学意义(P值均>0.05)。干预组无患者发生甲氧氯普胺不良反应。结论在吞服胶囊内镜的同时肌内注射甲氧氯普胺可在一定程度上降低胶囊内镜的胃内滞留率,对胃、小肠通过时间和全小肠检查完成率无明显影响。

Objective To investigate the effect of metoclopramide on gastric retention of capsule enteroscope （CE）. Methods From July 2012 to July 2015, a total of 60 patients undergoing capsule enteroscopy were enrolled in this prospective study. According to random number, the patients were divided into intervention group and control group, and there were 30 patients in each group. Metoclopramide （10 mg） was intramuscularly injected immediately after taking CE in the intervention group. The main observation index was the rate of gastric retention （CE in gastric over ! hour was considered as gastric retention）. Secondary observation indexes were gastric transit time, intestinal transit time and the rates of complete intestinal examination. Results CE successfully passed the stomach into duodenum in 55 patients. CE retained in the stomach in 4 patients of control group. CE could not be swallowed and need to be sent into duodenum in one patient of intervention group who was excluded from data analysis. The total rate of gastric retention was 6.78% （4/59）. The rate of gastric retention of intervention group was 0, which was significantly lower than that of control group （ 13.33%, X2 = 4. 148, P =0. 042）. Another patient of intervention group was also excluded from data analysis because of multifocal ulcerous stenosing enteritis. Eventually, 56 patients completed whole small intestinal examination （OE was not into cecum during working time in 2 cases, each in intervention group and control group）, and the total completion rate was 96.55% （56/58）. The completion rates of small intestinal examination of intervention group and control group were 96.43% （27/28） and 96.67% （29/30）, respectively （P〈0.05）. Gastric and intestinal transit time were （22.07± 15.78） min and （329.54±190.68） min in the intervention group, which was not significantly different from those in the control group （E22.27± 13.581 min, 1327.00 ±186. 871 min, both P〉0.05）. No adverse reaction related to metoclopramide occurred in intervention group. Conclusion Intramuscular injection of metoclopramide may decrease gastric retention of CE to some extents meanwhile it does not affect gastric and intestinal transit time or the rate of total intestinal examination： （Shanghai Med J, 2016, 39.. 671-674）