2022 年第 12 期 第 17 卷

经内镜活检孔道直接喷洒链霉蛋白酶对胃镜检查患者胃部可视度的影响

Effect of directly spraying pronase through the endoscopic biopsy channel on gastric visibility in patients undergoing gastroscopy

作者：孙亚梅 张杰

英文作者：Sun Yamei Zhang Jie

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：胃镜；链霉蛋白酶；可视度

英文关键词：Gastroscopy;Pronase;Visibility

• 摘要：

• 目的  探讨经内镜活检孔道直接喷洒链霉蛋白酶对胃镜检查患者胃部可视度的影响。方法 回顾性选取2021年9—12月于首都医科大学附属北京安贞医院消化内科行镇静/麻醉下胃镜检查的患者，所有患者常规服用盐酸利多卡因胶浆和二甲硅油散水悬液进行胃镜检查前准备，最终纳入胃镜检查过程中胃内仍有大量泡沫和黏液的患者为研究对象。通过内镜活检孔道直接喷洒链霉蛋白酶，观察评价链霉蛋白酶喷洒前后胃镜下胃底、胃体、胃角、胃窦各部位的黏膜可视度评分，并记录微小病灶的检出类型、胃镜检查时间及不良反应。结果  本研究共纳入97例患者，胃镜检查时间为6.30（4.61, 9.93）min。链霉蛋白酶喷洒后，胃底、胃体、胃角、胃窦黏膜可视度评分均低于链霉蛋白酶喷洒前，胃内各部位黏膜可视度总分低于链霉蛋白酶喷洒前［4（4,4）分比12（11,13）分］，差异有统计学意义（均P＜0.001）。97例患者中，共检出糜烂57例（58.8%）、溃疡11例（11.3%）、凹陷性病变9例（9.3%）、息肉22例（22.7%）。所有患者在操作期间均未出现不良反应，生命体征稳定。结论  对于使用祛泡剂准备后，胃镜检查过程中胃内可视度仍不满意的患者，通过内镜活检孔道直接喷洒链霉蛋白酶，可以显著提高胃内各部位的可视度，安全有效。

• Objective  To investigate the effect of directly spraying pronase through the endoscopic biopsy channel on gastric visibility in patients undergoing gastroscopy. Methods  From September to December 2021, patients undergoing gastroscopy under sedation/anesthesia were respectively selected in Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University. All patients were prepared by oral administration of lidocaine hydrochloride mucilage and simethicone powder before gastroscopic examination, and patients who still had a lot of foam and mucus in the stomach during the examination were included as subjects. Pronase was sprayed directly through the endoscopic biopsy channel. The mucosa visibility scores of fundus, body, horn and antrum of stomach were recorded before and after spraying pronase. The type of minute lesions, the gastroscopic examination time and adverse reactions were recorded. Results  A total of 97 patients were included in this study, with the gastroscopic examination time as 6.30 (4.61, 9.93) min. After spraying pronase, mucosa visibility scores of fundus, body, horn and antrum of stomach were lower than those before spraying, and the total mucosa visibility score was lower than that before spraying ［4（4,4） vs 12（11,13）］(all P<0.001). Among 97 patients, there were 57 cases (58.8%) of erosions, 11 cases (11.3%) of ulcers, 9 cases (9.3%) of depressed lesions, and 22 cases (22.7%) of polyps. No adverse reaction occurred during the operation, and patients′ vital signs were stable. Conclusion  In patients with unsatisfactory gastric visibility during gastroscopy after preparation with defoaming agent, spraying pronase directly through the endoscopic biopsy channel can significantly improve the visibility of various parts of the stomach, which is safe and effective.