不同剂量西甲硅油应用于儿童胃镜的随机对照研究

Application of different doses of simethicone in upper endoscopy for children:A randomized controlled study

目的 讨不同剂量西甲硅油对儿童胃镜操作的影响。方法 重庆医科大学附属儿童医院预约行胃镜检查的≥2岁儿童作为研究对象。采用随机数字表法对2022-03-01—2022-12-31预约行胃镜检查的患儿随机分4组:A组口服20 m L温水作为对照,B组口服40 mg西甲硅油,C组口服100 mg西甲硅油,D组口服200 mg西甲硅油。比较4组有效性指标(胃镜视野清晰度情况、胃镜操作时间、镜下冲洗例数)及安全性指标(氧饱和度下降例数)。结果 纳入患儿800例,每组200例,各组性别构成和年龄分布差异无统计学意义(χ^(2)=0.981、H=2.239,均P>0.05)。视野清晰度良好率:A组、B组、C组和D组分别为38.5%、66%、80.5%和78.5%,A组低于B组、C组及D组(χ^(2)_(AB)=30.331、χ^(2)_(AC)=73.203、χ^(2)_(AD)=65.905,均P<0.05);B组低于C组和D组(χ^(2)_(BC)=10.730、χ^(2)_(BD)=7.793,均P<0.05);C组与D组差异无统计学意义(P>0.05)。胃镜操作时间:B组(192.0±53.6)s、C组(169.0±45.8)s及D组(169.8±46.6)s显著短于A组(221.2±58.8)s(Z_(AB)=-4.412、Z_(AC)=-8.373、Z_(AD)=-8.023,均P<0.05);C组和D组短于B组(Z_(BC)=-4.5、Z_(BD)=-4.418,均P<0.05);C组与D组差异无统计学意义(P>0.05)。镜下冲洗例数:A组(76例)显著高于B组(24例)、C组(10例)及D组(11例,χ^(2)_(AB)=36.053、χ^(2)_(AC)=63.394、χ^(2)_(AD)=62.062,均P<0.05);B组高于C组和D组(χ^(2)_(BC)=6.076、χ^(2)_(BD)=5.292,均P<0.05);C组与D组差异无统计学意义(P>0.05)。氧饱和度下降例数:4组比较差异无统计学意义(P>0.05)。结论 童胃镜检查前口服西甲硅油可显著提升胃镜视野清晰度,100 mg西甲硅油即可达到理想的清洁效果。

Objective To compare the efficacy of different doses of simethicone on operation of upper endoscopy forchildren.Methods Patients aged ≥2 years old who received upper endoscopy in Children's Hospital of ChongqingMedical University from Mar.1 to Dec.31 of 2022 were included in this study.Study subjects were randomly assigned to 4 groups.Group A received 20 mL water before examination as control,Group B received 40 mg simethicone,Group Creceived 100 mg simethicone,and Group D received 200 mg simethicone.Visibility of upper endoscopy,proceduretime,cases requiring endoscopic flushing,and cases of oxygen desaturation were compared and analyzed.Results Atotal of 800 pediatric patients were included in this study,200 patients in each group.There were no significant differences regarding gender composition and meanage in each group(χ^(2)=0.981,H=2.239,P>0.05).The proportion of adequate visibility in Group A,Group B,Group C and Group D was 38.5%、66%、80.5% and 78.5%,respectively.The proportion ofadequate visibility in group A was significantly lowerthan that in the other groups(χ_(AB)^(2)=30.331,χ_(AC)^(2)=73.203,χ_(AD)^(2)=65.905,all P<0.05).The proportion ofadequate visibility in Group B was significantly lower than that in Group C and Group D(χ_(BC)^(2)=10.730,χ_(BD)^(2)=7.793,all P<0.05).No significant differences were detectedregarding proportion of adequate visibility between Group C and Group D(P>0.05).Procedure time in group B[(192.0±53.6)s],group C[(169.0 ± 45.8)s],and group D[(169.8 ± 46.6)s]was significant shorter than that in groupA[(221.2±58.8)](ZAB=-4.412,ZAC=-8.373,ZAD=-8.023,all P<0.05).Procedure time in Group C and Group D wassignificant shorter than that in Group B(ZBC=-4.5,ZBD=-4.418,all P <0.05).No significant differences were detectedregarding procedure time between Group C and Group D(P>0.05).Cases requiring endoscopic flushing in Group A(76 cases)were significantly higher than those in Group B(24 cases),Group C(10 cases),and Group D(11 cases)(χ_(AB)^(2)=36.053,χ_(AC)^(2)=63.394,χ_(AD)^(2)=62.062,all P<0.05).Cases requiring endoscopic flushing in Group B were significantlyhigher than those in Group C and Group D(χ_(BC)^(2)=6.076,χ_(BD)^(2)=5.292,all P<0.05).No significant differences weredetected regarding cases requiring endoscopic flushing between Group C and Group D(P>0.05).There were nosignificant differences regarding cases of oxygen desaturation among the 4 groups(P>0.05).Conclusion Premedicationof simethicone can significantly improve the visibility during upper endoscopy in children,and 100 mg simethicone isenough to achieve an ideal cleaning effect.