發(fā)布時間：2018-01-17 20:39

  本文關(guān)鍵詞：氫溴酸東莨菪堿在探頭式共聚焦胃鏡檢查中的臨床應(yīng)用分析　出處：《山東大學》2015年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 探頭式共聚焦激光顯微胃鏡 氫溴酸東莨菪堿 內(nèi)鏡檢查質(zhì)量評估

【摘要】：研究背景及目的：共聚焦激光顯微內(nèi)鏡(CLE)是目前唯一能夠達到活體組織病理學水平的內(nèi)鏡技術(shù),這種放大1000倍的圖像可清晰辨認組織結(jié)構(gòu)、細胞及亞細胞結(jié)構(gòu),即時準確的做出高分辨率的組織學診斷,并及時采取相應(yīng)治療措施,避免重復內(nèi)鏡檢查和多次活檢并發(fā)癥的發(fā)生。氫溴酸東莨菪堿為M膽堿受體阻滯藥,因其抗膽堿作用臨床上已被廣泛用于胃、十二指腸、結(jié)腸的纖維內(nèi)鏡檢查的術(shù)前準備。目前該藥在普通胃鏡操作中的作用已得到證實,既可以減輕患者的痛苦,又能有效的提高胃鏡檢查的質(zhì)量。然而在共聚焦激光顯微胃鏡檢查術(shù)中,解痙藥應(yīng)用的有效性并未得到證實。本試驗旨在研究氫溴酸東莨菪堿應(yīng)用于探頭式共聚焦激光顯微胃鏡(pCLE)檢查術(shù)中的有效性與安全性。研究方法：自2014年8月至2015年2月,,將山東大學齊魯醫(yī)院胃鏡室行探頭式共聚焦激光顯微胃鏡檢查術(shù)的門診患者(年齡為18-80歲且無氫溴酸東莨菪堿應(yīng)用禁忌者)隨機分為A、B兩組,A組給與氫溴酸東莨菪堿0.3mg (1l)肌注,B組給與等量生理鹽水(1m1)肌注。操作中共聚焦激光顯微內(nèi)鏡探頭探視病變部位及胃鏡檢查五個標準部位(胃竇大彎、小彎側(cè),胃體大彎、小彎側(cè),胃角)的共聚焦圖像并進行圖像實時評分,于可疑部位取病理送檢,記錄胃鏡操作時間及不良反應(yīng)發(fā)生次數(shù),統(tǒng)計兩組患者病變檢出率,對于取病理患者,以病理診斷為金標準統(tǒng)計兩組胃鏡診斷準確程度。比較兩組患者以上各項指標的差異。研究結(jié)果：本研究共納入患者122例,其中剔除6例,最終116例患者數(shù)據(jù)資料錄入分析。結(jié)果示兩組患者在性別組成、平均年齡、身高、體重、病變檢出率、診斷準確率、不良事件發(fā)生率方面,A、B兩組差異無統(tǒng)計學意義；在胃鏡檢查五個標準部位(胃竇大彎、小彎側(cè),胃體大彎、小彎側(cè),胃角)及病變部位的共聚焦圖像評分中,兩組胃竇大彎側(cè)、胃體大彎側(cè)圖像評分無統(tǒng)計學意義(X2=0.057,P=0.811；X2=2.939,P=0.086),而對于胃竇小彎側(cè),胃體小彎側(cè)、胃角部及病變部位的共聚焦圖像評分,A組圖像質(zhì)量明顯高于B組,且有統(tǒng)計學意義(X2=9.046,P=0.005；X2=4.417,P=0.036；X2=9.979,P=0.004；X2=8.849, P=0.006):與B組相比,A組胃鏡操作時間明顯縮短(t=2.075,P=0.04)。結(jié)論：在探頭式共聚焦激光顯微胃鏡檢查中,應(yīng)用氫溴酸東莨菪堿能有助于得到較高質(zhì)量的共聚焦圖像,且有效縮短胃鏡檢查時間。
[Abstract]:Background and objective: confocal laser microendoscopy (CLEs) is the only endoscopic technique capable of achieving the level of histopathology in vivo at present. Cell and subcellular structure, the immediate and accurate high-resolution histological diagnosis, and timely take appropriate treatment measures. To avoid repeated endoscopic examination and multiple biopsy complications. Scopolamine hydrobromide is a M-choline receptor blocker, because of its anticholine effect clinical has been widely used in the stomach and duodenum. Preoperative preparation for fibroendoscopy of colon. The role of the drug in general gastroscopy has been confirmed, which can alleviate the pain of patients. It can also effectively improve the quality of gastroscopy. However, in confocal laser microgastroscopy. The efficacy of antispasmodic was not confirmed. The purpose of this study was to study the application of scopolamine hydrobromide to probe confocal laser microgastroscopy (pCLEs). Effectiveness and safety of intraoperative examination. Methods: from August 2014 to February 2015. , the outpatients (aged 18-80 years with no contraindication of scopolamine hydrobromide) who underwent confocal laser microgastroscopy in the gastroscope room of Qilu Hospital of Shandong University were randomly divided into two groups. Group A was given scopolamine hydrobromide 0.3mg / l intramuscularly. Group B was given the same amount of normal saline (1ml) intramuscularly. The lesion site was visited by confocal laser microendoscopic probe and the five standard sites (great antral curvature, small curvature side, great curvature of gastric body, small curvature side) were examined by gastroscopy. The confocal image of gastric angle) was evaluated in real time. Pathological examination was performed at the suspected site. The operating time of gastroscope and the occurrence times of adverse reactions were recorded. The detection rate of pathological changes in the two groups was counted and the pathological patients were taken. The accuracy of gastroscope diagnosis in the two groups was calculated by using pathological diagnosis as gold standard. The differences of above indexes between the two groups were compared. Results: 122 patients were included in this study, 6 of them were excluded. The results showed that the sex composition, average age, height, weight, detection rate of pathological changes, diagnostic accuracy and incidence of adverse events in the two groups were significantly higher than those in the control group. There was no significant difference between the two groups. In gastroscopy examination of the five standard sites (great antral curvature, small curvature, great curvature of the body, small curvature, gastric angle) and the lesions of the confocal image score, two groups of the great curvature of the antrum. There was no statistical significance in the image score of the great flexural side of the stomach. The quality of confocal images in group A was significantly higher than that in group B for the lesser curvature of the antrum, the lesser curvature of the body of the stomach, the corner of the stomach and the location of the lesion. And there was statistical significance in X2P0. 046 and P0. 005; X2, 4.417, P0. 036; X2, 9.979, P0. 004; Compared with group B, the operation time of gastroscope in group A was significantly shorter than that in group B (8.849, P < 0.006). Conclusion: scopolamine hydrobromide can help to obtain high quality confocal image and shorten the time of endoscopy.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R573

【參考文獻】

相關(guān)期刊論文 前1條

1 章昱;陳小嫦;鐘敏;;間苯三酚在胃鏡檢查術(shù)中的應(yīng)用效果觀察[J];河北醫(yī)學;2010年06期

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