结直肠术后患者结肠镜检查前的肠道准备方法探讨
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摘要
目的改进结直肠术后患者肠道准备方法,提高结肠镜检查质量。方法选择拟行结肠镜检查的结直肠术后患者100例,分为两组,各50例。A组患者(同术前准备方法)结肠镜检查前5 h口服复方聚乙二醇电解质散(SF-PEG)328.8 g(3 000 ml);B组患者结肠镜检查前1日3餐后2 h分别服用SF-PEG27.4 g(250 ml),检查前5 h口服50%硫酸镁(MgSO4)100 ml,再喝温开水1 000 ml,至排泄液似清水样。服药后5 h行结肠镜检查。应用Boston肠道准备量表(BBPS)评分,对肠腔内气泡进行评分,比较两组患者肠道准备有效性、耐受性及安全性。结果 B组的结肠清洁程度BBPS总体评分(8.50±0.35)分,高于A组(7.35±1.25)分;B组进镜时间(3.85±1.20)min和退镜时间(6.25±0.60)min,少于A组进镜时间(5.35±1.75)min和退镜时间(8.20±0.85)min,差异均有统计学意义(P<0.05)。B组患者肠道准备接受率、再次肠道准备接受率和总体不良反应评分分别为96.0%、94.0%和(1.35±0.05)分;A组患者分别为86.0%、72.0%和(1.75±0.30)分;差异均有统计学意义(P<0.05),B组优于A组。结论结直肠术后患者肠镜检查前的肠道准备,采用间断冲击口服小剂量复方SF-PEG联合MgSO4,效果优于常规剂量。
Objective To improve the intestinal preparation method and improve the quality of colonoscopy in patients after colorectal surgery.Methods 100 patients with colorectal surgery were selected and divided into 2 groups,50 patients in each.Patients in A group(with preoperative preparation) received oral compound sulfatefree polyethylene glycol(SF-PEG) 328.8 g(3 000 ml) 5 h before colonoscopy.While patients in group B were taken SF-PEG 27.4 g(250 ml) 2 h after three meals the day before,and 50% Mgso4 100 ml was taken in the first 5 hours before the examination,and 1000 ml of warm water was drunk.5 h later for colonoscopy.The Boston bowel preparation scale(BBPS) was used to score and score the bubbles in the intestinal cavity,and the effectiveness,tolerance and safety of the intestinal preparation were compared in the two groups.Results The colonic cleanliness of group B was(8.50±0.35) with overall score of(7.35±1.25) higher than that of group A.Group B had(3.85±1.20) min of entry time and(6.25±0.60) min of remission time,which was less than group A.The time was(5.35±1.75) min and the remission time was(8.20±0.85) min.The difference was statistically significant(P<0.05).The prevalence of bowel preparation,the rate of re-preparation of bowel preparation,and the overall adverse reaction score in group B were 96.0%,94.0%,and(1.35±0.05) respectively; In group A,the patients were 86.0%,72.0%,and(1.75±0.30) respectively.The difference was statistically significant(P<0.05).The B group was superior to the A group.The enteric preparation of patients undergoing colorectal surgery should be treated with intermittent impact oral small dose compound polyethylene glycol electrolyte combined with magnesium sulfate.The effect is better than conventional dose.Conclusion In patients with colorectal surgery,patients with enteroscopy were prepared to take the intermittent of oral administration of small dose compound polyethylene glycol sulfate and magnesium sulfate,which can obtain the better effect of conventional oral dose.
Objective To improve the intestinal preparation method and improve the quality of colonoscopy in patients after colorectal surgery.Methods 100 patients with colorectal surgery were selected and divided into 2 groups,50 patients in each.Patients in A group(with preoperative preparation) received oral compound sulfatefree polyethylene glycol(SF-PEG) 328.8 g(3 000 ml) 5 h before colonoscopy.While patients in group B were taken SF-PEG 27.4 g(250 ml) 2 h after three meals the day before,and 50% Mgso4 100 ml was taken in the first 5 hours before the examination,and 1000 ml of warm water was drunk.5 h later for colonoscopy.The Boston bowel preparation scale(BBPS) was used to score and score the bubbles in the intestinal cavity,and the effectiveness,tolerance and safety of the intestinal preparation were compared in the two groups.Results The colonic cleanliness of group B was(8.50±0.35) with overall score of(7.35±1.25) higher than that of group A.Group B had(3.85±1.20) min of entry time and(6.25±0.60) min of remission time,which was less than group A.The time was(5.35±1.75) min and the remission time was(8.20±0.85) min.The difference was statistically significant(P<0.05).The prevalence of bowel preparation,the rate of re-preparation of bowel preparation,and the overall adverse reaction score in group B were 96.0%,94.0%,and(1.35±0.05) respectively; In group A,the patients were 86.0%,72.0%,and(1.75±0.30) respectively.The difference was statistically significant(P<0.05).The B group was superior to the A group.The enteric preparation of patients undergoing colorectal surgery should be treated with intermittent impact oral small dose compound polyethylene glycol electrolyte combined with magnesium sulfate.The effect is better than conventional dose.Conclusion In patients with colorectal surgery,patients with enteroscopy were prepared to take the intermittent of oral administration of small dose compound polyethylene glycol sulfate and magnesium sulfate,which can obtain the better effect of conventional oral dose.
引文
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[6]OHIGASHI S,HOSHINO Y,OHDE S,et al.Functional outcome,quality of life,and efficacy of probiotics in postoperative patients with colorectal cancer[J].Surg Today,2011,41(9):1200-1206.
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[8]MENZIES D,ELLIS H.Intestinal obstruction from adhesions--how big is the problem[J].Ann R Coll Surg Engl,1990,72(1):60-63.
[9]CAMILLERI M,FORD M J.Review article:colonic sensorimotor physiology in health and its alteration in constipation and diarrhoeal disorders[J].Aliment Pharmacol Ther,1998,12(4):287-302.
[10]葛伏,林万军.老年人结肠镜检查肠道准备的策略及特点[J].中华腔镜外科杂志:电子版,2017,10(3):182-185.[10]GE F,LIN W J.Strategies and characteristics of bowel preparation for colonoscopy in the elderly[J].Chinese Journal of Laparoscopic Surgery:Electronic Edition,2017,10(3):182-185.Chinese
[11]林炜炜,顾立扬,任玲,等.低剂量聚乙二醇联合硫酸镁用于肠道准备的效果评价[J].胃肠病学,2012,17(1):10-13.[11]LIN W W,GU L Y,REN L,et al.Evaluation of low-dose polyethylene glycol combined with magnesium sulfate in bowel preparation[J].Chin J Gastroenterol,2012,17(1):10-13.Chinese
[12]孟小芬,陈熹,杨屹,等.服药时间对结肠镜检查肠道准备效果的影响[J].中国内镜杂志,2016,22(11):21-23.[12]MENG X F,CHEN X,YANG Y,et al.Impact of the time of medicine-taking on bowel preparation of the colonoscopy[J].Chinese Journal of Endoscopy,2016,22(11):21-23.Chinese
[13]ROTONDANO G,RISPO A,BOTTIGLIERI M E,et al.Quality of bowel cleansing in hospitalized patients undergoing colonoscopy:a multicentre prospective regional study[J].Dig Liver Dis,2015,47(8):669-674.
[14]LU J,CAO Q,WANG X,et al.Application of oral lactulose in combination with polyethylene glycol electrolyte powder for colonoscopy bowel preparation in patients with constipation[J].Am J Ther,2016,23(4):e1020-e1024.
[2]LIM S W,SCO Y W,SINN D H,et al.Impact of previous gastric or colonic resection on polyethylene glycol bowel preparation for colonoscopy[J].Surgical Endoscopy,2012,26(6):1554-1559.
[3]卢乐,孟小芬,屈平敏,等.改良肠道准备法在便秘患者肠镜检查中的应用[J].中国内镜杂志,2017,23(7):30-34.[3]LU L,MENG X F,QU P M,et al.Effect of modified bowel preparation in patients with constipation undergoing colonoscopy[J].China Journal of Endoscopy,2017,23(7):30-34.Chinese
[4]ROME F.Guidelines-Rome III diagnostic criteria for functional gastrointestinal disorders[J].J Gastrointestin Liver Dis,2006,15(3):307-312.
[5]CALDERWOOD A H,SCHROY P C,LIEBERMAN D A,et al.Boston bowel preparation scale scores provide a standardized definition of adequate for describing bowel cleanliness[J].Gastrointest Endosc,2014,80(2):269-276.
[6]OHIGASHI S,HOSHINO Y,OHDE S,et al.Functional outcome,quality of life,and efficacy of probiotics in postoperative patients with colorectal cancer[J].Surg Today,2011,41(9):1200-1206.
[7]LIAKAKOS T,THOMAKOS N,FINE P M,et al.Peritoneal adhesions:etiology,pathophysiology,and clinical significance.Recent advances in prevention and management[J].Dig Surg,2001,18(4):260-273.
[8]MENZIES D,ELLIS H.Intestinal obstruction from adhesions--how big is the problem[J].Ann R Coll Surg Engl,1990,72(1):60-63.
[9]CAMILLERI M,FORD M J.Review article:colonic sensorimotor physiology in health and its alteration in constipation and diarrhoeal disorders[J].Aliment Pharmacol Ther,1998,12(4):287-302.
[10]葛伏,林万军.老年人结肠镜检查肠道准备的策略及特点[J].中华腔镜外科杂志:电子版,2017,10(3):182-185.[10]GE F,LIN W J.Strategies and characteristics of bowel preparation for colonoscopy in the elderly[J].Chinese Journal of Laparoscopic Surgery:Electronic Edition,2017,10(3):182-185.Chinese
[11]林炜炜,顾立扬,任玲,等.低剂量聚乙二醇联合硫酸镁用于肠道准备的效果评价[J].胃肠病学,2012,17(1):10-13.[11]LIN W W,GU L Y,REN L,et al.Evaluation of low-dose polyethylene glycol combined with magnesium sulfate in bowel preparation[J].Chin J Gastroenterol,2012,17(1):10-13.Chinese
[12]孟小芬,陈熹,杨屹,等.服药时间对结肠镜检查肠道准备效果的影响[J].中国内镜杂志,2016,22(11):21-23.[12]MENG X F,CHEN X,YANG Y,et al.Impact of the time of medicine-taking on bowel preparation of the colonoscopy[J].Chinese Journal of Endoscopy,2016,22(11):21-23.Chinese
[13]ROTONDANO G,RISPO A,BOTTIGLIERI M E,et al.Quality of bowel cleansing in hospitalized patients undergoing colonoscopy:a multicentre prospective regional study[J].Dig Liver Dis,2015,47(8):669-674.
[14]LU J,CAO Q,WANG X,et al.Application of oral lactulose in combination with polyethylene glycol electrolyte powder for colonoscopy bowel preparation in patients with constipation[J].Am J Ther,2016,23(4):e1020-e1024.