不同干预方式在既往肠道准备不满意患者中的应用效果比较
|
摘要
目的比较电话再教育与分次口服复方聚乙二醇电解质散等渗溶液在既往肠道准备不满意患者中的应用效果。方法收集2017年9月至2018年6月在安徽医科大学第三附属医院再次行肠镜检查且既往肠道准备不满意的234例患者的临床资料,按随机数表法分为三组,最终229例患者完成检查,所有患者肠道准备用药均为3L复方聚乙二醇电解质散溶液。干预1组(76例)在其肠道准备当日晨间予以电话通知再次宣教,干预2组(78例)予以同日分次口服药物方案,对照组(75例)给予连续口服药物方案。在肠镜检查过程中使用波士顿评分量表统计肠道准备分值。设计调查问卷收集患者服药期间不良反应及倾向于何种肠道准备。结果干预1组、干预2组、对照组患者的右半结肠波士顿评分均值分别为(2.11±0.56)分、(2.26±0.61)分和(2.03±0.59)分,差异有统计学意义(P<0.05),其中干预2组的波士顿评分最高,与对照组比较差异有统计学意义(P<0.05);干预1组、干预2组、对照组患者服药期间不良反应发生率分别为35.5%、17.9%、32.0%,差异有统计学意义(P<0.05),其中干预2组不良反应发生率最低,与干预1组比较差异有统计学意义(P<0.05);干预1组、干预2组、对照组患者<5 mm腺瘤检出率分别为14.5%、20.5%、9.3%,差异无统计学意义(P>0.05);干预1组、干预2组、对照组患者希望更换肠道准备方案的发生率分别为36.8%、33.3%、40.0%,差异无统计学意义(P>0.05)。结论既往肠道准备不满意的患者再次行肠道准备时可以采用聚乙二醇等渗溶液分剂量服用方式提高肠道清洁度并降低不良反应,不建议采用加强宣教的方式。但是仍需要进一步探索更加个性化,简便,省时的肠道准备方案。
Objective To compare the telephone re-education and oral administration of the compound polyethylene glycol electrolyte solution in patients with poor bowel preparation. Methods Information was collected from 234 patients who underwent colonoscopy at the Third Affiliated Hospital of Anhui Medical University from September 2017 to June 2018 and were unsatisfied with previous bowel preparations. The 234 patients were randomly assigned into 3 groups and 229 patients finally completed the examination. All patients received bowel preparation with 3 L compound polyethylene glycol electrolyte solution. Intervention group 1(76 cases) received telephone re-education in the morning on the day of bowel preparation, intervention group 2(78 cases) were given split-dose oral drug regimen on the same day, and control group(75 cases) was given continuous oral drug regimen. The bowel preparation score was counted during the colonoscopy using the Boston Rating Scale. The self-designed questionnaire was used to collect adverse reactions during the patient's medication and to determine which bowel preparations were preferred. Results The mean values of Boston scores in the right colon of intervention group 1, intervention group 2 and control group were 2.11±0.56,2.26±0.61, and 2.03±0.59, respectively, and the differences was statistically significant among the three groups(P<0.05),with the score in intervention group 2 the highest(P<0.05). The incidence of adverse reactions during medication of intervention group 1, intervention group 2, and the control group was 35.5%. 17.9%, and 32.0%, and the differences were statistically significant(P<0.05), with the incidence the lowest in intervention group 2(P<0.05). The detection rate of adenomas in intervention group 1, intervention group 2, and the control group was 14.5%, 20.5%, and 9.3%, respectively,and the differences were not statistically significant among the three groups(P>0.05). The proportions of patients wanted to change bowel preparation regimen in intervention group 1, intervention group 2, control group were 36.8%,33.3%, and 40.0%, respectively, and the differences were not statistically significant among the three groups(P>0.05).Conclusion Patients with poor bowel preparations may be treated with split-dose compound polyethylene glycol electrolyte solution to improve intestinal cleanliness and reduce adverse reactions. It is not recommended to strengthen education. However, there is still a need to further explore a more personalized, simple, and time-saving bowel preparation program to improve the cleanliness of the entire intestine.
Objective To compare the telephone re-education and oral administration of the compound polyethylene glycol electrolyte solution in patients with poor bowel preparation. Methods Information was collected from 234 patients who underwent colonoscopy at the Third Affiliated Hospital of Anhui Medical University from September 2017 to June 2018 and were unsatisfied with previous bowel preparations. The 234 patients were randomly assigned into 3 groups and 229 patients finally completed the examination. All patients received bowel preparation with 3 L compound polyethylene glycol electrolyte solution. Intervention group 1(76 cases) received telephone re-education in the morning on the day of bowel preparation, intervention group 2(78 cases) were given split-dose oral drug regimen on the same day, and control group(75 cases) was given continuous oral drug regimen. The bowel preparation score was counted during the colonoscopy using the Boston Rating Scale. The self-designed questionnaire was used to collect adverse reactions during the patient's medication and to determine which bowel preparations were preferred. Results The mean values of Boston scores in the right colon of intervention group 1, intervention group 2 and control group were 2.11±0.56,2.26±0.61, and 2.03±0.59, respectively, and the differences was statistically significant among the three groups(P<0.05),with the score in intervention group 2 the highest(P<0.05). The incidence of adverse reactions during medication of intervention group 1, intervention group 2, and the control group was 35.5%. 17.9%, and 32.0%, and the differences were statistically significant(P<0.05), with the incidence the lowest in intervention group 2(P<0.05). The detection rate of adenomas in intervention group 1, intervention group 2, and the control group was 14.5%, 20.5%, and 9.3%, respectively,and the differences were not statistically significant among the three groups(P>0.05). The proportions of patients wanted to change bowel preparation regimen in intervention group 1, intervention group 2, control group were 36.8%,33.3%, and 40.0%, respectively, and the differences were not statistically significant among the three groups(P>0.05).Conclusion Patients with poor bowel preparations may be treated with split-dose compound polyethylene glycol electrolyte solution to improve intestinal cleanliness and reduce adverse reactions. It is not recommended to strengthen education. However, there is still a need to further explore a more personalized, simple, and time-saving bowel preparation program to improve the cleanliness of the entire intestine.
引文
[1]中华医学会消化内镜学分会,中国抗癌协会肿瘤内镜学专业委员会.中国早期结直肠癌筛查及内镜诊治指南(2014年,北京)[J].中华消化内镜杂志, 2015, 32(6):341-360.
[2] JOHNSON DA, BARKUN AN, COHEN LB, et al. Optimizing ade-quacy of bowel cleansing for colonoscopy:recommendations fromthe US Multi-Society Task Force on Colorectal Cancer[J]. Am JGastroenterol, 2014, 109(10):1528-1545.
[3] HASSAN C, BRETTHAUER M, KAMINSKI MF, et al. Bowel prep-aration for colonoscopy:European Society of Gastrointestinal Endos-copy(ESGE)guideline[J]. Endoscopy, 2013, 45(2):142-150.
[4] CHENG CL, LIU NJ, TANG JH, et al. Predictors of suboptimal bow-el preparation using 3-l of polyethylene glycol for an outpatient colo-noscopy:a prospective observational study[J]. Dig Dis Sci, 2017, 62(2):345-351.
[5] IBANEZ M, PARRA-BLANCO A, ZABALLA P, et al. Usefulness ofan intensive bowel cleansing strategy for repeat colonoscopy afterpreparation failure[J]. Dis Colon Rectum, 2011, 54(12):1578-1584.
[6] SALTZMAN JR, CASH BD, PASHA SF, et al. Bowel preparation be-fore colonoscopy[J]. Gastrointestinal Endoscopy, 2015, 81(4):781-794.
[7] GIMENO-GARCIA AZ, HERNANDEZ G, ALDEA A, et al. Compar-ison of two intensive bowel cleansing regimens in patients with previ-ous poor bowel preparation:a randomized controlled study[J]. Am JGastroenterol, 2017, 112(6):951-958.
[8] WALTER B, KLARE P, STREHLE K, et al. Improving the qualityand acceptance of colonoscopy preparation by reinforced patient edu-cation with short message service:results from a randomized, multi-center study(PERICLES-II)[J]. Gastrointestinal Endoscopy, 2018.
[9] MOHAMED R, HILSDEN RJ, DUBE C, et al. Split-dose polyethyl-ene glycol is superior to single dose for colonoscopy preparation:re-sults of a randomized controlled trial[J]. Can J Gastroenterol Hepa-tol, 2016, 2016:3181459.
[10] RADAELLI F, PAGGI S, HASSAN C, et al. Split-dose preparationfor colonoscopy increases adenoma detection rate:a randomised con-trolled trial in an organised screening programme[J]. Gut, 2017, 66(2):270-277.
[11] LAI EJ, CALDERWOOD AH, DOROS G, et al. The Boston bowelpreparation scale:a valid and reliable instrument for colonosco-py-oriented research[J]. Gastrointest Endosc, 2009, 69(3 Pt 2):620-625.
[12]中华医学会消化内镜学分会.中国消化内镜诊疗相关肠道准备共识意见[J].中华消化内镜杂志, 2013, 30(10):541-549.
[13] LI Y, JIA X, LIU B, et al. Randomized controlled trial:Standard ver-sus supplemental bowel preparation in patients with Bristol stoolform 1 and 2[J]. PLoS One, 2017, 12(2):e171563.
[14]孟小芬,杨屹,张迪,等.复方聚乙二醇电解质散联合石蜡油在便秘患者肠道准备中的应用[J].中国内镜杂志, 2018, 24(7):37-40.
[15] YEE R, MANOHARAN S, HALL C, et al. Optimizing bowel prepa-ration for colonoscopy:what are the predictors of an inadequatepreparation?[J]. Am J Surg, 2015, 209(5):787-792, 792.
[16]李青云,肖鹏,孙洋洋.复方聚乙二醇电解质溶液剂量和服用方法对结肠镜前肠道准备的效果评估[J].中国内镜杂志, 2018, 24(4):23-27.
[17] VARUGHESE S, KUMAR AR, GEORGE A, et al. Morning-onlyone-gallon polyethylene glycol improves bowel cleansing for after-noon colonoscopies:a randomized endoscopist-blinded prospectivestudy[J]. Am J Gastroenterol, 2010, 105(11):2368-2374.
[18] CHOKSHI RV, HOVIS CE, HOLLANDER T, et al. Prevalence ofmissed adenomas in patients with inadequate bowel preparation onscreening colonoscopy[J]. Gastrointest Endosc, 2012, 75(6):1197-1203.
[2] JOHNSON DA, BARKUN AN, COHEN LB, et al. Optimizing ade-quacy of bowel cleansing for colonoscopy:recommendations fromthe US Multi-Society Task Force on Colorectal Cancer[J]. Am JGastroenterol, 2014, 109(10):1528-1545.
[3] HASSAN C, BRETTHAUER M, KAMINSKI MF, et al. Bowel prep-aration for colonoscopy:European Society of Gastrointestinal Endos-copy(ESGE)guideline[J]. Endoscopy, 2013, 45(2):142-150.
[4] CHENG CL, LIU NJ, TANG JH, et al. Predictors of suboptimal bow-el preparation using 3-l of polyethylene glycol for an outpatient colo-noscopy:a prospective observational study[J]. Dig Dis Sci, 2017, 62(2):345-351.
[5] IBANEZ M, PARRA-BLANCO A, ZABALLA P, et al. Usefulness ofan intensive bowel cleansing strategy for repeat colonoscopy afterpreparation failure[J]. Dis Colon Rectum, 2011, 54(12):1578-1584.
[6] SALTZMAN JR, CASH BD, PASHA SF, et al. Bowel preparation be-fore colonoscopy[J]. Gastrointestinal Endoscopy, 2015, 81(4):781-794.
[7] GIMENO-GARCIA AZ, HERNANDEZ G, ALDEA A, et al. Compar-ison of two intensive bowel cleansing regimens in patients with previ-ous poor bowel preparation:a randomized controlled study[J]. Am JGastroenterol, 2017, 112(6):951-958.
[8] WALTER B, KLARE P, STREHLE K, et al. Improving the qualityand acceptance of colonoscopy preparation by reinforced patient edu-cation with short message service:results from a randomized, multi-center study(PERICLES-II)[J]. Gastrointestinal Endoscopy, 2018.
[9] MOHAMED R, HILSDEN RJ, DUBE C, et al. Split-dose polyethyl-ene glycol is superior to single dose for colonoscopy preparation:re-sults of a randomized controlled trial[J]. Can J Gastroenterol Hepa-tol, 2016, 2016:3181459.
[10] RADAELLI F, PAGGI S, HASSAN C, et al. Split-dose preparationfor colonoscopy increases adenoma detection rate:a randomised con-trolled trial in an organised screening programme[J]. Gut, 2017, 66(2):270-277.
[11] LAI EJ, CALDERWOOD AH, DOROS G, et al. The Boston bowelpreparation scale:a valid and reliable instrument for colonosco-py-oriented research[J]. Gastrointest Endosc, 2009, 69(3 Pt 2):620-625.
[12]中华医学会消化内镜学分会.中国消化内镜诊疗相关肠道准备共识意见[J].中华消化内镜杂志, 2013, 30(10):541-549.
[13] LI Y, JIA X, LIU B, et al. Randomized controlled trial:Standard ver-sus supplemental bowel preparation in patients with Bristol stoolform 1 and 2[J]. PLoS One, 2017, 12(2):e171563.
[14]孟小芬,杨屹,张迪,等.复方聚乙二醇电解质散联合石蜡油在便秘患者肠道准备中的应用[J].中国内镜杂志, 2018, 24(7):37-40.
[15] YEE R, MANOHARAN S, HALL C, et al. Optimizing bowel prepa-ration for colonoscopy:what are the predictors of an inadequatepreparation?[J]. Am J Surg, 2015, 209(5):787-792, 792.
[16]李青云,肖鹏,孙洋洋.复方聚乙二醇电解质溶液剂量和服用方法对结肠镜前肠道准备的效果评估[J].中国内镜杂志, 2018, 24(4):23-27.
[17] VARUGHESE S, KUMAR AR, GEORGE A, et al. Morning-onlyone-gallon polyethylene glycol improves bowel cleansing for after-noon colonoscopies:a randomized endoscopist-blinded prospectivestudy[J]. Am J Gastroenterol, 2010, 105(11):2368-2374.
[18] CHOKSHI RV, HOVIS CE, HOLLANDER T, et al. Prevalence ofmissed adenomas in patients with inadequate bowel preparation onscreening colonoscopy[J]. Gastrointest Endosc, 2012, 75(6):1197-1203.