梅托克洛普拉米德在患有上部胃肠道活跃出血的患者内镜视觉化胃的有效性:双盲随机对照试验
Thanrada Vimonsuntirungsri1, Rattikorn Thungsuk2, Papatsakorn Nopjaroonsri2
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
静脉注射的美托克洛普拉米德并没有改善活性上部胃肠道出血 (UGIB) 的整体内镜可视化. 然而,它减少了重复内镜的需要,并改善了胃损伤患者的胃可视化.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 药理学 药理学是指药理学的学科.
背景情况:
- 目前的指导方针建议用红色素改善上部胃肠道出血 (UGIB) 的内镜视图.
- 证据证明,美托克洛普拉米德在活跃的UGIB中有效,特别是在增强可视化方面,是有限的.
- 与红色素相比,美托克洛普拉米德的可访问性更大.
研究的目的:
- 评估静脉注射的美托克洛普拉米德在活跃UGIB患者内镜检查期间改善胃可视化的有效性.
- 在一项随机对照试验中,将美托克洛普拉米德对内镜可视化的影响与安慰剂进行比较.
主要方法:
- 进行了一项双盲随机对照试验,其中62名患者经历了活跃的UGIB.
- 患者被分配给接受静脉注射的美托克洛普拉米德或安慰剂.
- 主要结局是通过胃肠视觉分数 (EVS) 评估的足够的内镜可视化.
主要成果:
- 梅托克洛普拉米德并没有显著改善整体充足的内镜可视化 (77.4%对61.6%,P=0.16).
- 甲托克洛普拉米德组显示,在72小时内重复内镜的发生率明显较低 (3.2%对22.6%,P=0.02).
- 亚组分析显示,在患有胃病变的患者中,甲托克洛普拉米德改善了胃视觉 (92.9%与50%相比,P=0.03).
结论:
- 静脉注射的美托克洛普拉米德在活跃的UGIB中没有增强整体内镜可视化,但减少了对第二次内镜的需求.
- 在由胃病变引起的UGIB病例中,Metoclopramide证明改善了胃视觉,特别是在 fundus 中.
- 进一步的研究可能会澄清metoclopramide在特定的UGIB场景中的作用.
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