链霉蛋白酶提高胃镜检查图像可见度的前瞻性、多中心、双盲、随机对照临床研究

目的评价并比较胃镜检查前应用链霉蛋白酶、二甲基硅油及二者联合使用对提高可见度的有效性。方法5个中心选择440例胃镜检查患者随机分为3组，A组170例，口服链霉蛋白酶和碳酸氢钠；B组170例，VIN--甲基硅油和碳酸氢钠；C组100例，口服二甲基硅油、链霉蛋白酶和碳酸氢钠。观察主要疗效指标为胃镜直接观察胃窦、胃体、胃底3个部位黏膜可见度总评分。次要评价指标为胃镜检查喷洒亚甲蓝后观察胃窦、胃体以及胃底部3处的黏膜可见度总评分。结果胃镜检查直接观察可见度总评分在3组间的差异具有统计学意义（P〈0．0001），C组总评分高于A组（P=0．0001），A组总评分高于B组（P=0．0019）；喷亚甲蓝后胃镜检查观察可见度总评分在3组间的差异具有统计学意义（P〈0．0001），C组总评分高于A组（P：0．0054），A组总评分高于B组（P〈0．0001）。结论胃镜检查前联合应用链霉蛋白酶和二甲基硅油可明显提高可见度，具有良好安全性和广泛的应用价值。

Effectiveness of premedication with pronase for visualization of the mucosa during endoscopy： a double-blinded,multi-center,prospective, randomized study

Objective To assess the efficacy arid safety of premedicaton with pronase before upper gastrointestinal endoscopy （UGI）. Methods A total of 440 outpatients from 5 centers were randomly as- signed to receive endoscopy with one of three premedications as follows： dimethylpolysiloxane （DMPS） and pronase （group A, n = 170） ; DMPS and sodium bicarbonate （group B, n = 170） ; DMPS, pronase and so- dium bicarbonate （group C, n = 100）. Six endoscopists, who were unaware of the premedication types, cal- culated the visibility scores （range, 1 to 4） of the antrum, gastric body, and fundus. The sum of the scores from the three locations was defined as the total visibility score. Results With regards to routine white light endoscopy, the total visibility score of group C was significantly higher than that of group A （P = 0. 0001 ）, and the score of group A was significantly higher than that of group B （P = 0. 0019 ）. Concerning chromoen- doscopy, the total visibility score of group C was significantly higher than that of group A （ P = 0. 0054 , and the score of group A was also significantly higher than that of group B （P 〈 0. 0001 ）. Conclusion Com- bined application of pronase, dimethylpolysiloxane, and sodium bicarbonate before UGI endoscopy signifi- cantly improves endoscopic visualization.