两种肠道准备方法在结肠镜检查前肠道准备的效果比较

目的:探索结肠镜检查前有效、方便的肠道准备方法.方法:将81例拟行结肠镜检查的患者随机分为观察组和对照组.观察组39例采用复方大承气汤与复方聚乙二醇电解质散联合口服清洁肠道;对照组42例采用单纯复方聚乙二醇电解质散口服清洁肠道.观察肠道清洁满意度和患者不良反应.结果:观察组肠道清洁满意度92.3%,对照组肠道清洁满意度为92.9%,差异无统计学意义(P0.05);观察组在恶心、呕吐、腹胀方面的不良反应明显少于对照组(P0.05).结论:采用复方大承气汤加复方聚乙二醇电解质散口服用于结肠镜检查前肠道准备,患者舒适度提高,减少药物用量,降低医疗费用,肠道内气泡较少,有利于医师操作和诊断.     

西甲硅油乳剂在结肠镜检查中的应用与研究

目的 研究西甲硅油乳剂在结肠镜检查术前肠道准备中的应用价值.方法 将200例接受结肠镜检查的患者随机分为两组,实验组100例,对照组100例.实验组给予聚乙二醇电解质散+西甲硅油乳剂,对照组给予口服聚乙二醇电解质散.观察二组的效果.结果 实验组肠腔内气泡存在量明显少于对照组,术后腹胀程度明显轻于对照组,内镜医师操作满意度优于对照组(P＜0.05),而两组肠道清洁程度无差异(P＞0.05).结论 在结肠镜检查术前肠道准备中应用西甲硅油乳剂能够消除泡沫,提高视野清晰度,减少术后腹胀等不良反应,提高术者操作舒适度,缩短操作时间.     

聚乙二醇电解质散在结肠镜检查前肠道准备中的应用观察

将498例行结肠镜检查的患者随机分为实验组(240例)和对照组(258例),实验组口服聚乙二醇电解质散清肠,对照组口服果导加硫酸镁清肠.发现实验组肠道准备时间较对照组明显缩短,P＜0.05;两组清洁肠道有效率及肠腔内气泡情况无明显差异;实验组不良反应明显少于对照组;耐受性实验组优于对照组.认为聚乙二醇电解质散应用于结肠镜检查前肠道准备安全有效,准备时间短.     

4种不同肠道准备方法对无痛结肠镜检查老年患者机体的影响

目的探讨4种不同肠道准备方法对无痛结肠镜检查老年患者机体的影响。方法选取2015年1~6月于该院行结肠镜检查的老年患者136例。准备方法不同随机分成4组,每组34例。A组:给予复方聚乙二醇电解质;B组:口服33%硫酸镁;C组:口服20%甘露醇;D组:采用结肠透析机清洁灌肠。结果 B组、C组、D组间清洁满意率无显著性差异(P0.05)且均显著高于A组(P0.05)。D组祛泡效果最好,优于A组、B组、C组(P0.05);且A组优于B组和C组(P0.05)。A组、D组患者5项机体指标值,准备前后无显著差异(P0.05);B组、C组患者准备前后体温、心率、血氧饱和度(Sp O2)值无显著性差异(P0.05);B组患者准备后收缩压显著低于准备前(P0.05);C组患者准备后收缩压和舒张压较准备前显著降低(P0.05)。结论选用结肠透析机灌肠作为老年结肠镜检查肠道准备方法,对老年机体影响小,安全可靠,值得临床推广。     

结肠镜检查前单次和分次服用复方匹可硫酸钠肠道清洁效果的临床观察

目的 探讨单次和分次服用复方匹可硫酸钠在结肠镜检查前患者肠道准备中的应用效果。方法 纳入我院行无痛结肠镜检查的患者226例,采用随机数字表法分为单次服药组和分次服药组各113例。分次服药组：检查前一日20:00将复方匹可硫酸钠颗粒1袋溶于150 mL冷水服用,30 min后饮用1 500～2 000 mL澄清液体,2 h内饮完;检查当日4:30将第2袋溶于150 mL冷水服用,30 min后饮用750 mL的澄清液体,1 h内饮完。单次服药组：检查前4～6 h将复方匹可硫酸钠颗粒2袋溶于300 mL冷水服用,30 min后饮2 500～3 000 mL澄清液体,2 h内饮完。观察两组结肠镜检查患者肠道清洁度、息肉检出率、服用口味满意度、肠道准备体验感和不适症状。结果 单次服药组患者肠道准备评分在左半结肠、横结肠、右半结肠及总评分均高于分次服药组,差异均有统计学意义(P<0.05);单次服药组肠道息肉检出率(32.7%)高于分次服药组(20.4%),差异有统计学意义(P<0.05);两组患者服用口味满意程度比较无显著性差异(P>0.05);分次服药组肠道准备体验评分高于...     

不同时间口服磷酸钠盐作肠道准备的效果及患者舒适度的比较

目的探讨不同时间口服磷酸钠盐进行术前肠道准备对患者舒适度的影响。方法选择泌尿外科择期手术患者360例,按随机数字表法随机分为观察组和对照组,每组180例。两组均应用磷酸钠盐口服溶液45 ml稀释后服用进行肠道准备,观察组术前1 d 16:00服药,对照组术前1 d 19:00服药。比较两组肠道准备的效果及患者舒适度情况。结果观察组患者肠道清洁效果及患者舒适度均优于对照组,差异有统计学意义(P0.01)。结论择期手术患者术前不需要饮食限制下,术前1 d 16:00口服磷酸钠盐口服溶液作肠道准备清洁效果好,病人易于接受,副反应发生率低,明显优于术前1 d 19:00服药行肠道准备者。     

单倍剂量磷酸钠盐口服溶液联合西甲硅油乳剂在结肠镜检查肠道准备中的应用

背景:良好的肠道准备是结肠镜检查和治疗的必要前提。双倍剂量(45 mL x2)磷酸钠盐口服溶液用于肠道准备清洁效果良好,但易产生气泡而影响观察。目的:评价单倍剂量(45 mL)磷酸钠盐口服溶液联合消泡剂西甲硅油乳剂用于结肠镜检查肠道准备的效果。方法:纳入疑有结直肠病变而拟接受结肠镜检查且符合纳入和排除标准者110例,随机分为试验组和对照组。试验组检查当日晨服用磷酸钠盐口服溶液45 mL+温开水750 mL,1 h后口服西甲硅油乳剂30 mL;对照组服用磷酸钠盐口服溶液90 mL+温开水1500 mL。比较两组肠道清洁效果、祛泡效果、术后腹胀程度、结肠镜检查时间等指标。结果:试验组肠道清洁效果与对照组相似(A、B级:89.1%对80.0%,P>0.05),祛泡效果显著优于对照组(A、B级:83.6%对56.4%,P<0.05),术后腹胀程度显著轻于对照组(无或轻度腹胀:89.1%对70.9%,P<0.05),结肠镜检查时间较对照组显著缩短[(7.1±3.2)min对(9.2±3.7)min,P<0·05]。结论:单倍剂量磷酸钠盐口服溶液联合西甲硅油乳剂用于结肠镜检查的肠道准备效果良好,安全性和耐受性高,值得推荐应用于临床。     

行走功能状态与老年人结肠镜检查前肠道准备的相关性

目的探讨老年人行走功能状态与结肠镜检查前肠道准备质量的关系。方法选取2017年1月至2018年3月北京老年医院消化科住院期间行结肠镜检查的153例老年患者。检查前通过Barthel指数评价患者行走功能,并根据行走是否独立将患者分为行走正常组82例及行走困难组71例。2组患者采取相同的肠道准备方法,记录肠道清洁完成情况并计算清洁有效率。采用SPSS 19.0统计软件进行分析。根据数据类型,组间比较采用独立样本t检验或χ2检验。相关性分析采用Spearman秩相关检验。结果与行走困难组比较,行走正常组患者完整服用肠道清洁剂的比例显著升高[87.8%(72/82) vs63.4%(45/71),P0.01]。而在未完整服用肠道清洁剂的患者中,与行走困难组比较,行走正常组患者因不能忍受频繁排便的比例显著降低,差异有统计学意义[8.54%(7/82) vs 30.99%(22/71),P=0.001],但因不良反应导致未完整服用肠道清洁剂的比例2组差异无统计学意义[3. 66%(3/82) vs 5. 63%(4/71),P=0.705]。Spearman秩相关分析显示,行走功能状态与肠道准备清洁质量呈正相关(r=0.333,P0.01)。结论老年患者行走功能状态与结肠镜检查前肠道准备质量相关,行走困难影响患者肠道准备质量。     

饮食对肠镜检查肠道准备的影响

肠道检查前通常禁食8h,常会引起受检者低血糖、全身乏力、心慌、出汗等检查耐受性下降的情况,为此我们对肠镜检查前饮食对肠道准备的影响进行了观察,现报告如下。 一、对象与方法 1.对近年因腹痛、腹泻、便秘、便血及腹部包块等住院、门诊患者及健康体检者240例,随机分成A、B、C、D4组。4组均于检查前1d进普通饮食,A组:检查前8h禁食不禁水;B组:可进流汁饮食如糖水、汤、牛奶;C组:可进无渣饮食及半流质,如面条、豆腐、稀饭;D组:普食,可以有蔬菜水果。于检查当日上午 9～11时日服甘露醇或电解质洗肠液,在 30min内饮水1500 ml以上,并口服西沙比利 10 mg,进行肠道检查,观察记录肠镜所见及全身情况。240例中资料完整的179例,男 93例,女86例,年龄9～76岁,平均29.5岁。 肠道清洁的判定及分级见参考文献[1,2]:I级为最佳状态,IV级无法完成镜检。     

老年结肠镜检查患者个体化肠道准备的效果观察

目的探讨个体化肠道准备方法对老年患者结肠镜检查前肠道准备的效果。方法将2012年6至7月收治的40例老年患者作为对照组,2012年8至9月收治的45例老年患者作为观察组。对照组采用常规肠道准备方法进行肠道准备,观察组采用个体化肠道准备方法进行肠道准备。两组患者常规给予相关的解释,对照组按常规于检查当天早晨口服泻药,观察组先评估患者的病情、排便情况等,制定适合患者的个体化肠道准备计划并实施。比较两组患者的不良反应情况及清肠效果。结果观察组不良反应少,清肠效果明显优于对照组。结论个体化肠道准备方法用于老年患者结肠镜检查前肠道准备可减少不良反应,提高肠道清洁效果。     

Preoperative bowel preparation

A survey of 500 clinically active, board-certified colon and rectal surgeons in the United States and Canada was conducted to obtain data regarding current methods of bowel preparation for elective colorectal surgery. A review of recent publications on preoperative bowel preparation was used to compare the current literature recommendations with the actual practice among the group surveyed. Responses were received from 352 of 500 colorectal surgeons to whom questionnaires were sent (70 percent response rate). All respondents used a mechanical preparation and some form of antibiotics. The favorite antibiotic regimen was oral antimicrobials combined with systemic antibiotics (88 percent). Concomitant administration of oral neomycin-erythromycin base and a systemic second generation cephalosporin active against both anaerobic and aerobic colonic bacteria, together with oral polyethelene glycol electrolyte mechanical colonic cleansing, was the most popular method of preoperative bowel preparation (58 percent). The second most frequent method of mechanical bowel cleansing consisted of conventional enemas, dietary restrictions, and cathartic preparations (36 percent). Mannitol solution (5 percent), and whole-gut irrigation per nasogastric tube (1 percent) were the least popular methods of mechanical bowel cleansing. The literature supports the current methods of preoperative bowel preparation used by the vast majority of surgeons surveyed.Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

Antimicrobial bowel preparation

It has been suggested that wound infection rates after colorectal operations are influenced more by the presence of adequate tissue levels of antimicrobials at the time of contamination than by the extent of bacterial colonization of the intestinal lumen. There are, however, theoretical grounds for the belief that both levels are important. The authors therefore conducted a random control trial in 119 consecutive patients undergoing elective colorectal operations, comparing the results in a group receiving purely parenteral antimicrobial prophylaxis with those in one having a combined oral and parenteral regimen. The results in 83 contemporary nonrandomized patients, all of whom had the combined prophylactic regimen, are also reported. Oral bowel preparation resulted in a significantly smaller number of operation cultures showing growth of fecal gram-negative aerobes and anaerobes than did the purely parenteral regimen. There were more isolations of enterococci in the combined group but the excess did not achieve statistical significance. The rates of infective complications were higher in the parenteral than in the combined group, the difference in wound infection rates being statistically significant; the figures were 27.6 percent and 13.9 percent, respectively (P=.04). It is concluded that, in colorectal operations, it is advisable not only to ensure adequate tissue levels of antimicrobials but also to reduce the risk of endogenous bacterial infection by partially decontaminating the bowel.     

Physiologic effects of bowel preparation

PURPOSE: Despite the universal use of bowel preparation before colonoscopy and colorectal surgery, the physiologic effects have not been described in a standardized setting. This study was designed to investigate the physiologic effects of bowel preparation.METHODS: In a prospective study, 12 healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance, plasma and extracellular volume, balance function, and biochemical parameters were measured.RESULTS: Bowel preparation led to a significant decrease in exercise capacity (median, 9 percent) and weight (median, 1.2 kg). Plasma osmolality was significantly increased from 287 to 290 mmol kg^–1, as well as increased phosphate and urea concentrations, whereas calcium and potassium concentrations decreased significantly after bowel preparation. No differences in plasma or extracellular volumes were seen. Orthostatic tolerance and balance function did not change after bowel preparation.CONCLUSIONS: Bowel preparation has significant adverse physiologic effects, which may be attributed to dehydration. The majority of these findings is small and may not be of clinical relevance in otherwise healthy patients undergoing bowel preparation and following recommendations for oral fluid intake.Supported by grants from the University of Copenhagen and the Danish Research Council (no. 22-01-0160).Presented at the meeting of the American Society of Anesthesiologists, San Francisco, California, October 11 to 15, 2003.     

Esophagogastroduodenoscopy-assisted bowel preparation for colonoscopy

AIM: To compare the quality and tolerance of esophagogastroduodenoscopy (EGD)-assisted and conventional split-dose polyethylene glycol electrolyte solution for inpatient colonoscopy.METHODS: The study was a randomized controlled trial in hospitalized patients. Hospitalized patients undergoing colonoscopy the day following EGD for evaluation of gastrointestinal (GI) bleeding or other symptoms. Patients randomized to either EGD-assisted bowel prep [2 L polyethylene glycol (PEG) administered endoscopically into distal duodenum at time of EGD, plus 1 L PEG orally the following day] or conventional-PEG (2 L PEG orally the evening prior and 1 L PEG orally the following day). The main outcome measurements are bowel preparation quality and patient tolerance of bowel prep.RESULTS: Forty-two patients randomized to EGD-assisted bowel prep and 40 patients to conventional-PEG. Overall mean ± SD preparation quality was superior for EGD-PEG (4.1 ± 2.8) vs conventional-PEG (6.5 ± 3.1; P = 0.0005). Seventy-four percent of patients rated EGD-PEG as easy or slightly difficult to tolerate compared to 46% for standard-PEG (P = 0.0133). Mean EGD-procedural time was greater for EGD-assisted subject (24 ± 10 min) compared to conventional-PEG prep subjects (15 ± 7 min; P < 0.0001). Conscious sedation requirements did not differ between groups. There were no significant prep-related adverse events in either group.CONCLUSION: In selected hospitalized patients, compared to a conventional split-dose regimen, use of EGD to administer the majority of PEG solution improves patient tolerance and quality of bowel preparation for colonoscopy.     

Methods of bowel preparation for sigmoidoscopy

Summary 1. Two hundred and twenty-two patients were examined by sigmoidoscopy following the use of one of four cleansing preparations: 50% magnesium sulphate solution, Fleet's solution, normal saline, and Dulcolax tablets and suppositories.2. Fifty per cent magnesium sulphate produced the highest percentage of excellently cleansed patients—69.7% in 96 patients.3. Almost equally useful, for the purpose described in this report, is Fleet's solution—58.7 per cent excellent cleansing, 84.7 per cent satisfactory cleansing (E and G), and less than 10 per cent marked congestion in 46 patients.4. Dulcolax, though practical, easily administered, and only mildly irritating, as employed in our study, gave only moderately satisfactory results—with 66 per cent satisfactory cleansing preparations in 53 patients.5. Normal saline was the least effective cleansing agent and was abandoned because of the poor results obtained—48.1 per cent satisfactory in 27 patients.6. There was little significant difference in side effects and rectal irritation in the preparations used, with the exception of normal saline, which produced much less congestion and mucus secretion.7. Cleansing the rectosigmoid, prior to sigmoidoscopy, by the method described in this report, using 50% magnesium sulphate, is a simple, efficient, safe, and inexpensive method of preparation, well tolerated by the patient.     

Laparoscopic colectomy without mechanical bowel preparation

Background Mechanical bowel preparation prior to colorectal surgery may reduce infectious complications, facilitate tumor localization, and allow intraoperative colonoscopy, if required. However, recent data suggest that mechanical bowel preparation may not facilitate a reduction in infectious complications. During laparoscopic colectomy, manual palpation is blunt, thereby potentially compromising tumor localization. The aim of this study was to assess the utility of mechanical bowel preparation in laparoscopic colectomy.Materials and methods A retrospective medical record review of all patients who underwent laparoscopic colectomy was performed. Patients were divided into two groups: those who had preoperative mechanical bowel preparation (Group A) or those who did not (Group B). All relevant perioperative data were reviewed and compared.Results Two hundred patients underwent laparoscopic colectomy; 68 (34%) were in Group A and 132 (66%) were in Group B. Sixteen (8%) patients required intraoperative colonoscopy for localization and were evenly distributed between the two groups. The incidence of conversion to laparotomy was slightly higher in Group B (14 vs 9%) due to difficult localization in some cases; however, this difference did not reach statistical significance. Furthermore, there was no significant difference in the postoperative complication rate between the two groups. Specifically, an anastomotic leak and a wound infection were recorded in 4 and 12% of patients in Group A compared to 3 and 17% in Group B, respectively.Conclusions Laparoscopic colectomy may be safely performed without preoperative mechanical bowel preparation, although difficult localization may lead to a slightly higher conversion rate. Appropriate patient selection for laparoscopic colectomy without mechanical bowel preparation is essential. Furthermore, bowel preparation should be considered in cases of small and nonpalpable lesions.Dual first authorship—Zmora and Lebedyev, the first two authors, equally contributed to this study.Presented as a poster at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Denver, CO, March 31–April 3, 2004.     

Improved capsule endoscopy after bowel preparation

BACKGROUND: The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small-bowel wall and complete passage through the small bowel. This study examined the effect of bowel preparation on the volume of intestinal content and on small-bowel transit. METHODS: Sixty-one consecutive patients (34 men, 27 women; mean age 56 years, range 17-88 years) were enrolled in the study. Although not randomized, 33 patients received a bowel preparation, and 28 had no preparation. Gastric emptying, small-bowel transit time, overall preparation assessment, and bowel-wall visualization were evaluated by 3 investigators who were unaware of whether the patient had undergone bowel preparation. RESULTS: Small-bowel transit time was significantly shorter in patients with bowel preparation (median 213 minutes: 95% CI[190, 267]) than in those without preparation (median 253 minutes: 95% CI[228, 307]) (p <0.01). The capsule reached the cecum in 97% of patients in the bowel-preparation group, compared with 76% in the nonpreparation group (p=0.02). Bowel preparation improved the quality of visualization significantly; this effect was more pronounced in the distal small bowel. CONCLUSIONS: This study demonstrated that bowel preparation accelerates small-bowel capsule transit and leads to a higher rate of complete capsule endoscopy. Visualization of the small bowel was improved by bowel preparation. Bowel preparation before capsule endoscopy is recommended.     

Predictors of inadequate bowel preparation for colonoscopy

OBJECTIVE: Inadequate preparation of the bowel for colonoscopy can result in both missed pathological lesions and cancelled procedures. We looked prospectively at the quality of colonic preparation and evaluated potential associations between specific patient characteristics and inadequate colonic preparation. METHODS: Data were gathered on consecutive patients presenting for colonoscopy who received either a polyethylene glycol lavage or oral sodium phosphate bowel preparation. Patient demographic and medical history information was gathered before scheduled colonoscopy. The endoscopist evaluated the preparation quality during the procedure. Complete data were gathered on 649 of 714 eligible patients (90.8%). Possible predictors of inadequate colonic preparation were analyzed using univariate statistics and multivariate logistic regression models. RESULTS: An inadequate colonic preparation was reported in 21.7% of observed colonoscopies. Only 18% of patients with an inadequate colonic preparation reported a failure to adequately follow preparation instructions. A later colonoscopy starting time, a reported failure to follow preparation instructions, inpatient status, a procedural indication of constipation, taking tricyclic antidepressants, male gender, and a history of cirrhosis, stroke or dementia were all independent predictors of an inadequate colon preparation (all p < 0.05). A procedural indication of previous polypectomy was a negative predictor of inadequate colonic preparation (p < 0.05). CONCLUSION: Several patient characteristics were significantly associated with colonic preparation quality independent of preparation type, compliance with preparation instructions, and procedure starting time. This information may help to identify patients at an increased risk for inadequate colonic preparation for whom alternative preparation protocols would be appropriate.     

Boston肠道准备量表应用的信度评估

目的 分析应用Boston肠道准备量表评价结肠镜肠道准备质量的信度(可靠性).方法 来自广东多家医院的49名临床医务人员观看Boston医学中心提供的Boston肠道准备量表解说演示视频,然后对视频中的3例测试肠镜视频进行评分,分析不同受试者间评分的一致性.13名医务人员于3个月后重复上述测试,分析2次评分的一致性.结果 不同观察者间Boston肠道准备量表评分的组内相关系数为0.987,95％ CI:0.949 ～1.000.同一观察者2次评分间Boston肠道准备量表评分的组内相关系数为0.713,95％ CI:0.452 ～0.849.结论 Boston肠道准备量表评价肠道准备质量可靠性高,易于掌握,值得进一步作效度验证.