摘要
背景和目的
消化内镜的普及是近年来消化领域进展的一个重要方面,也是目前处理许多消化系统疾病的一项有效手段。结肠镜下治疗要求高质量肠道准备,保证操作过程顺利,减轻病人痛苦。本研究采用中药制剂与平衡针针麻技术联合应用,旨在发掘出一种更适应人文、更接近天然的新型提高肠镜检查质量的方法,促进肠镜检查及其相关治疗的发展。
方法
1.文献研究
通过对国内外关于肠镜检查质量的研究现状及进展进行分析,首先,目前肠道准备多采用口服导泻法,存在清洁度差、不良反应多、患者难以耐受等诸多问题；另一方面,目前无痛肠镜检查多采用药物麻醉方法,存在各种风险及并发症,安全性差。故如何提高肠道准备质量是目前消化系统学科的一个重要课题之一
2.临床研究
本研究遵循随机、对照的方法,将符合纳入标准的肠镜检查患者共200例随机分为试验组(100例)和对照组(100例),试验组采用肠道准备1号方和2号方做肠道准备,并在肠镜检查过程中施以平衡针针麻技术；对照组采用番泻叶+甘露醇做肠道准备,检查过程中不进行干预。制作肠镜检查质量问卷调查表,记录患者服药后排便情况、不良反应、肠道清洁效果,以及在肠镜检查过程中平衡针的镇痛效果和患者的耐受性。建立数据库,运用统计学方法,客观地评价中药制剂与平衡针针麻技术联合应用对提高肠镜检查质量的效果。
结果
1.在服药口感方面,试验组与对照组的服药口感差异无统计学意义(P>0.05)；但中药制剂的服药口感拥有更高的患者接受程度。
2.在服药后排便反应方面,试验组与对照组在排便持续时间和排便次数上有显著性差异(P<0.05)。试验组排便持续时间明显短于对照组,排便次数也少于对照组。两组药物的起效时间差异有统计学意义(P<0.05)；试验组大多于第二次服药后出现首次排便,不会影响患者睡眠,减少了患者的不便。
3.在服药后不良反应方面,试验组和对照组不良反应发生率有统计学差异(P<0.05),对照组明显高于试验组。两组恶心、呕吐的发生率大致相当,对照组更容易出现腹胀、头晕、乏力、饥饿感。在腹痛的严重程度上,两组有着显著性差异(P<0.05),以对照组患者的腹痛程度为重。
4.在洁肠效果方面,两组药物洁肠效果比较无显著性差异(P>0.05),试验组和对照组的洁肠效果相当。试验组的洁肠有效率(92%)高于对照组(86%)。
5.在针麻效果方面,两组患者腹痛分级具有显著性差异(P<0.05),说明采用平衡针针麻干预后可减轻患者腹痛。患者在清醒的状态下进行检查,更能有效的避免不良并发症的发生,更具有安全性。另外,两组患者中腹胀的发生率均较高,分别达到32%、59%。经统计分析,两组患者其他不适症状的发生无明显差异(P>0.05)。
6.在患者耐受性方面,两组患者的耐受度有明显差异(P<0.05)。试验组有52%的患者可以较舒适的完成肠镜检查,而对照组这一比例只有32%。
结论
本研究在分析总结近年来各种常用肠道准备方法的优势和特点的基础上,结合中医“下法”的应用特色,并将传统的针灸技术应用于肠镜检查中,旨在初步探讨如何以一种简便易行、疗效稳定、安全性高的方法提高肠镜检查质量。通过初步研究得出的结论如下：
1.中药制剂安全性高,患者耐受性好,服药后腹痛、腹胀等不良反应发生率低。
2.中药制剂患者排便时间短,排便次数少,不影响患者睡眠,不会引起乏力等虚脱表现。
3.中药制剂与对照组相比较,并没有更好的洁肠效果。
4.中药制剂的口感欠佳,和对照组一样,容易引起恶心及呕吐,但可接受度仍然高于对照组。
5.针麻操作简便,安全性好,不存在药物麻醉的各种风险及并发症,无特殊禁忌症,可减轻患者在肠镜过程中的不适,使患者能较好地配合完成检查。
Background and Objective
The popularity of digestive endoscopy is one of the most important progress digestion domain, currently is also an effective means to deal with many digestive disease. Colonoscopy treatment demand for high-quality bowel preparation to ensure operation process smoothly, relieve pain. This study was to dig out a new method, which is new, more humane and more natural, so that we can improve the quality and promote the therapeutical development of colonscopy, by using Chinese Medicine and technology of balance's Acupuncture.
Methods
1. Literature research
According to the analysis of research situation and progress on the quality of colonoscopy both at home and abroad, we found that currently bowel preparation is used more oral cathartic method, This generates many problems: poor cleanness, more adverse reactions, poor patients s degrees; On the other hand, At present, medicinal anesthetics is the most way in painless endoscopy, there are adverse reactions of narcotic drugs and anesthetic risks, It is poor security. So how to improve the quality of colonscopy is one of the most important subjects in gastroenterology.
2. Clinical Research
This study abide by the random and comparing method, A total of 200 patients were randomly divided into the experimental group (n=100) and the control group (n=100). The patients from the experimental group do bowel preparation with bowel preparation 1st formula and 2nd formula, with technology of balance's Acupuncture in endoscopic checking process; and the control group do bowel preparation with senna and mannitol, No intervention in endoscopic checking process. We made unified questionnaire to evaluate the quality of colonoscopy. The patients' bowel condition, adverse reactions, cleanning effect, balance's Acupuncture effect, patients tolerated.
Result
1. There was no significantly different between two groups in drug taste (P>0.05), but the acceptance rate of drug taste was higher in the experimental group compared with the control group.
2. There were significant differences between the experimental group and the control group in defecation duration and defecation frequency(P<0.05), the defecation duration of the control group was longer than the experimental group, and the total number of bowel frequency was bigger in the control group compared with the experimental group. There was another significant difference between two groups in drug effect-acting period(P<0.05), the experimental group won't affect patient Morpheus, and reduce the patients of inconvenience.
3. The incidence of side effects was lower in the experimental group compared with the control group, there was significant difference(P<0.05). The incident of nausea, vomiting was roughly equal between two groups, but there was more abdominal distension, dizziness, weakness, hunger. The incidence of abdominal pain was significantly different between two groups(P <0.05).
4. There was no significant difference between the two groups in the effective rate of bowel preparation (P>0.05), but the total effective rate of bowel preparation was better in the experimental group compared with the control group.
5. There was significant different in degree of abdominal pain during endoscopic checking process (P<0.05), this shows that balance's Acupuncture Can relieve patients abdominal pain. Patients in the waking state under examination will avoid adverse events, It is safer than normal. Besides, The incidence of abdominal distension was high in two groups(32%,59%), there was no significant difference between the two groups in other side effects (P >0.05)
6. The patients'tolerance in the experimental group was superior to that in the control group (P<0.05), more than 52 percent of patients in the experimental group can be more comfortable completed, and the proportion is 32% in the control group.
Conclus ion
By analyzing various common bowel preparation method's advantages and characteristics in recent years, Combined with the application of traditional Chinese medicine " diarrhea method " characteristic, The traditional acupuncture technique is applied in endoscopic check, aimed at preliminary discussion on how to enhance endoscopic check quality by a simple and feasible, efficacy stability, high security methods. Through the preliminary research conclusions are as follows:
1. The experimental group medicine was higher safe, patients was with superior tolerability, abdominal pain, abdominal distension adverse reactions were in a low incidence.
2. In the experimental group, Patients' defecate time is shorter, defecate total number was less, it won't affect patients, such as the lack of sleep, won't cause collapse performance.
3. The colonic cleaning effect of experimental group is as good as control group.
4. The experimental group medicine's mouthfeel is poor, easily cause nausea and vomiting as well as the control group, but the acceptable degrees was still higher than those in the control group.
5. Acupuncture anesthesia's operation is simple, good safety, there is no some of risk and complications as drug anesthesia, no special contraindications, It can reduce the patients' unwell in the process of colonoscopy, so that patients can better cooperate to complete inspection.
引文
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