复方聚乙二醇电解质散联合乳果糖口服液分次口服在便秘患者肠镜检查前肠道准备中应用效果

目的 探讨复方聚乙二醇电解质散(PEG)联合乳果糖口服液分次口服对于便秘患者肠镜检查前肠道准备的应用效果.方法 选取自2017年1月至2019年12月在北部战区总医院门诊及住院部拟行电子结肠镜检查的120例便秘患者为研究对象.按不同肠道准备方法将患者随机分为3组,每组各40例.A组采用PEG+乳果糖口服溶液分次口服方法...     

结肠镜检查前不同肠道准备方法的效果观察与比较

电子结肠镜检查是诊断和治疗结肠疾病的重要临床医疗手段。良好的肠道准备是电子结肠镜检查的前提条件,如果肠道清洁较差将影响结肠镜观察,对一些肠道疾病的发现有很大限制,选择清洁效果好的肠道清洁剂有助于结肠镜检查更好地发现结肠病变而较少漏诊,目前临床上应用于肠道准备的药物较多,效果不一。本研究比较了复方聚乙二醇电解质散、甘露醇、硫酸镁3种肠道准备方法的清洁效果及不良反应,现将观察结果报道如下。1材料与方法     

结肠镜检查肠道准备四种方法效果比较

 目的 比较肠道四种准备方法的清洁有效度、不良反应发生情况及耐受性。方法 选取320例拟行结肠镜检查的患者,随机分成4组,采用单盲、前瞻性、对照研究。A组复方聚乙二醇电解质散(polyethylene glycol electrolyte powder,PEG)4 L分次口服,B组PEG 2 L+酚酞片口服,C组服用PEG 2 L,D组服用硫酸镁+酚酞片。比较4组患者肠道清洁程度、不良反应发生情况及耐受性。结果 A组、B组肠道清洁效果较理想,清洁有效率分别为90.0％、88.8％,优于C、D两组的73.8％、67.5％(P<0.05);D组不良反应总发生率为42.5％,A、B、C组分别21.3％、25.0％、27.6％,D组明显高于A、B、C组(P<0.05);D组耐受性为75.0%,也明显低于A、B、C组的95％、92.5％、87.5％(P<0.05)。结论 PEG 4 L分次口服,以及低剂量PEG联合其他有协同作用的泻药,安全有效,耐受性也较好,可提供较理想的肠道清洁效果。     

结肠镜检查前不同低渣饮食持续时间肠道准备效果对比观察

目的:观察比较结肠镜检查前低渣饮食1天、3天对肠道准备效果和患者耐受性的影响。方法:将某医院结肠镜检查前预行肠道准备的门诊和住院患者221例随机分为低渣饮食1天组111例和低渣饮食3天组110例。所有患者均服用复方聚乙二醇电解质散和西甲硅油进行肠道准备。比较两组肠道准备质量,以及盲肠插镜时间、退镜时间、息肉检出率、患者耐受度和是否愿意再次采用该种饮食方式进行肠道准备等。肠道准备质量采用波士顿肠道准备量表(BBPS)进行评估,患者耐受度采用饥饿-舒适度标尺进行评价。结果:两组肠道准备BBPS总分低渣饮食1天组(6.54±1.45)分,与低渣饮食3天组(6.55±1.86)分比较,差异不显著(P>0.05)。两组在盲肠插镜时间、退镜时间、息肉检出率、患者耐受度等方面比较,差异不显著(P>0.05)。低渣饮食1天组受试者认为该种饮食方式"很简单遵从或简单遵从"的比例非常显著高于低渣饮食3天组(P<0.01),低渣饮食1天组受试者愿意再次采用该种饮食方式进行肠道准备的比例显著高于低渣饮食3天组(P<0.05)。结论:低渣饮食1天或3天对结肠镜检查前肠道准备质量没有显著影...     

结肠镜检查前两种清洁剂肠道准备效果比较

<正>清洁肠道准备是结肠镜检查及治疗的必要条件,我院对150例患者检查前口服不同的清洁剂对肠道准备的效果进行了比较,现报告如下。1资料和方法1.1一般资料本组观察对象120例,其中男64例,女56例;年龄19～85岁。采用随机数字表分为两组,观察组     

单一应用磷酸钠盐口服溶液在大肠癌术前肠道准备中的临床观察

目的探讨单一应用磷酸钠盐口服溶液在大肠癌术前肠道准备中的清洁效果、不良反应和耐受性。方法将212例需做术前肠道准备的大肠癌患者随机分为四组:A组53例,口服磷酸钠盐口服溶液;B组55例,口服磷酸钠盐口服溶液联合磷酸钠盐灌肠液肛入;C组51例口服聚乙二醇电解质溶液;D组53例,口服硫酸镁溶液。观察4种不同肠道准备方法的肠道清洁有效率、不良反应率和耐受性。结果A组患者的肠道清洁有效率显著优于C组(P=0.031),而与B组、D组相比均无统计学差异(P>0.05)。A组患者在腹胀及恶心发生率方面显著低于D组(P=0.037,0.008),而在腹痛、腹胀、恶心、呕吐方面A组与B组、C组相比均无统计学差异(P>0.05)。A组患者的耐受性显著优于D组(P=0.001),而与B组、C组比较均无统计学差异(P=0.570,0.379)。结论 单一应用磷酸钠盐口服溶液用于大肠癌术前肠道准备的肠道清洁有效率高,且不良反应少,患者耐受性好。     

结肠镜检查前肠道准备清洁效果285例对比分析

肠道清洁准备工作是电子结肠镜检查的一个重要环节,它直接影响检查与治疗是否能够顺利完成.虽然,目前常用的肠道准备方法很多,但是否适合于每位患者,并能保证肠道准备的效果良好,常难肯定[1].……     

便塞停用于结肠镜检查肠道准备的效果观察

肠道准备的好坏是影响纤维结肠镜检查及内镜下治疗能否成功的关键。目前大多数医院纤维结肠镜检查前的肠道准备仍采用口服甘露醇、洗肠液、硫酸镁、蓖麻油等泻剂或清洁灌肠法，其缺点是用法繁琐，需大量饮水，一些患者尤其是年老体弱或有心、脑、肾疾病者难以接受；口服甘露醇法在行内镜下治疗时容易发生肠内爆炸［１，２］。为了寻求效果较好且易于为患者接受的肠道准备方法，我们观察了口服便塞停片用于纤维结肠镜检查肠道准备的效果并与洗肠液进行比较。１　资料与方法１１０例行结肠镜检查者均有消化道症状，其中以腹泻为主诉就诊者４１…     

3种结肠镜前肠道准备方法效果对比及临床应用

结肠镜前肠道准备条件直接关乎镜检结果,甚至关乎微小病变是否漏诊,故肠道准备对内镜医师来说至关重要。但现在肠道准备的多种方法是否适合于每位患者,同时做到清洁效果良好,这一点值得我们临床探讨。因此,探讨不同肠道准备方法的优劣,对于结肠镜检查前准备是十分必要的。现我院结肠镜检查肠道准备常用3种方法。     

个体化肠道准备方案在静脉麻醉下老年患者肠镜检查中的应用

 目的 探讨个体化肠道准备方案在老年患者肠镜检查中的应用。方法 选取2021-03至2022-03在解放军总医院第二医学中心消化内镜中心丙泊酚镇静麻醉下、接受无痛肠镜检查的老年患者98例,随机分为对照组与观察组,每组49例。对照组采用常规肠道准备,观察组采用个体化的肠道准备方案下的肠镜检查前肠道准备。对比两组肠道准备清洁度及患者对此肠道准备方案的满意度。结果 观察组波士顿肠道准备量表得分为(7.83±0.35)分,高于对照组的(6.91±0.73)分,差异有统计学意义(P＜0.05);两组患者满意度比较,观察组满意率98.00%高于对照组的79.60%,差异有统计学意义(P＜0.05)。结论 应用个体化肠道准备方案,波士顿评分高,清洁度好,患者满意度更高,值得推广。     

不同剂量布托啡诺复合丙泊酚靶控输注在老年患者结肠镜检查中的比较

目的 观察不同剂量布托啡诺复合丙泊酚靶控输注在老年患者纤维结肠镜检查中的可行性和安全性.方法 选择ASA Ⅰ～Ⅱ级结肠镜检查老年患者160例,随机分成4组,一组为对照组,使用丙泊酚复合芬太尼1.0μg/kg（F组）,另外3组复合使用布托啡诺,分为布托啡诺10μg/kg组（B10组）,布托啡诺15μg/kg组（B15组）和布托啡诺20μg/kg组（B20组）,每组40例.4组丙泊酚血药浓度3.0μg/ml靶控输注.观察麻醉前后患者循环变化、麻醉质量评分以及不良反应.结果 4组患者无痛结肠镜检查都顺利完成,各组结肠镜检查后MAP、HR均有不同程度的下降,以F组为著（P〈0.05）,B20组丙泊酚用量明显减少（P〈0.05）,但苏醒时间延长.4组麻醉优良率无明显差异,不良反应发生率都在可接受范围.结论 布托啡诺10~15μg/kg复合靶控输注丙泊酚在老年患者结肠镜手术麻醉中血流动力学相对稳定,无明显不良反应,安全有效.     

Different patterns of lymphoscintigraphic findings in patients with intestinal lymphangiectasia

Technetium-99m antimony sulfide colloid lymphoscintigraphy conveniently demonstrates intestinal leakage of lymph in patients with intestinal lymphangiectasia. However, we found no intestinal radioactivity in some patients. We evaluated lymphoscintigraphic findings and compared them with clinical data. Technetium-99m antimony colloid lymphoscintigraphy was performed in 12 patients (age, 8.9+/-6.4 years; male:female=8:4) with histologically proven intestinal lymphangiectasia. After subcutaneous injection of 103.6 MBq of technetium-99m antimony colloid into the webs of both feet, sequential abdominal images were obtained up to 24 h post-injection. Four patients underwent technetium-99m methylene diphosphonate bone scintigraphy. Patients were divided into two groups according to the presence or absence of intestinal radioactivity. Five showed intestinal activity (Group 1), but seven did not (Group 2). No Group 1 patient had a history of ascites, while all Group 2 patients had ascites as the initial manifestation. Serum total protein and albumin levels were significantly lower in Group 1 patients than in Group 2 patients. In three Group 1 patients, technetium-99m methylene diphosphonate bone scintigraphy revealed intestinal radioactivity, while in one Group 2 patient this was not found. We observed two types of lymphoscintigraphic pattern in patients with intestinal lymphangiectasia. To clarify the exact pathophysiology, further study is required.     

老年人肺挫伤58例临床分析

报告年龄６０岁以上老年人肺挫伤５８例,其中死亡６例,死亡率１０．３％,其余均治愈。分析结果表明,尽早明确诊断,处理合并伤,积极应用呼吸机,合理应用抗生素及防治并发症是救治成功的关键。     

A simplified approach to virtual colonoscopy using different intestinal preparations: preliminary experience with regard to quality, accuracy and patient acceptability

Purpose

The authors assessed the quality, diagnostic accuracy and patient acceptability of computed tomography (CT) colonography performed using a simplified bowel preparation and software for post-processing digital elimination of stool and fluid data from images compared with the examination obtained with conventional preparation.

Materials and methods

Two groups of 40 consecutive asymptomatic patients aged between 48 and 72 years underwent CT colonography. In group A, the CT scan was performed with conventional bowel preparation (a full cathartic dose and oral contrast medium to tag any residue in the 3 days preceding the study). In the second group, CT colonography was performed after a reduced bowel preparation, with the oral contrast medium for residue tagging being administered only on the day of the investigation. Examination quality, diagnostic performance and patient acceptability (rated with a self-completed questionnaire) in the two groups of patients were compared by using the McNemar test.

Results

No significant difference was obtained with regard to examination quality (180 vs. 165 segments free from stools and fluid, p>0.05) and overall diagnostic accuracy (16/17 colonic polyps detected in group A and 12/13 in group B, p>0.05). The questionnaires revealed a greater acceptability of the reduced bowel preparation compared with the standard procedure (p=0.01).

Conclusions

In asymptomatic patients, the use of software for post-processing digital elimination of residue from images in conjunction with reduced bowel preparation does not reduce examination quality or diagnostic performance when compared with the conventional CT colonography technique and is more acceptable to and better tolerated by the patient.     

The value of colonoscopy and double-contrast barium-enema examinations in the evaluation of patients with subacute and chronic lower intestinal bleeding

We examined 136 consecutive patients with histories of guaiac positive stool examinations, bright red blood per rectum, or hematochezia to determine the value of the double-contrast barium-enema (DC-BE) examination and colonoscopy/proctoscopy in establishing bleeding sites. If examination findings were analyzed in conjunction with findings of visual examination of the anal area, the difference in the respective sensitivities of the two examinations was not statistically significant. If findings at the visual inspection were excluded, the DC-BE examination missed 45 of 155 proved bleeding sites (sensitivity, 71%) and 13 of 35 nonbleeding lesions (sensitivity for all lesions 70%), while colonoscopy missed 13 of 155 bleeding sites (sensitivity, 92%) and seven of 35 nonbleeding lesions (sensitivity for all lesions, 90%). The sensitivity of both methods was similar if all rectal and anal lesions were excluded. Only eight additional lesions (all polyps) were found in 78 patients who had bleeding internal and external hemorrhoids, anal fissures, and anal tears, and seven of these were found in patients who were older than 50 years of age. We conclude that colonoscopy is superior to the DC-BE examination in the detection of bleeding sites but similar in results to the DC-BE examination if lesions in the anal canal and rectum are excluded. The routine use of the DC-BE examination in patients with superficial lesions in the anal canal should be discouraged unless the patient has persistent bleeding or is 50 years old or older.     

4种微生态药物对豚鼠小肠屏障作用的实验研究

 肠乐、乐托尔、整肠生、促菌生的临床用途相似,但疗效评价不一.取豚鼠80只随机分组、给药,禁食24 h后就各药对豚鼠小肠的屏障作用进行实验研究.结果显示,4种药对大剂量四环素所致豚鼠小肠液pH、Eh增高有明显调节作用(P<0.01),能保护小肠粘膜上皮细胞结构完整,改善大剂量四环素对SP的影响,维持正常肠蠕动.提示:此4药对肠道均有程度不等的屏障保护作用.过于加大微生态药物剂量不利于维持正常肠功能,同时口服大剂量抗生素,肠乐等对肠道的屏障作用即受到一定抑制.     

MR colonography in patients with incomplete conventional colonoscopy

PURPOSE: To assess dark-lumen magnetic resonance (MR) colonography for the evaluation of colonic segments in patients in whom conventional colonoscopy could not be completed. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Within 24 hours of incomplete conventional colonoscopy, 37 patients (22 women, 15 men; age range, 25-63 years) underwent MR colonography. Contrast material-enhanced T1-weighted three-dimensional images were collected after rectal administration of water for colonic distention. Data from MR colonography were evaluated by two radiologists. With a three-point scale, image quality was characterized in terms of colonic distention (1 = good; 2 = moderate, diagnostic; and 3 = poor, nondiagnostic) and presence of artifacts (1 = none; 2 = moderate, diagnostic; and 3 = extensive, nondiagnostic). Depiction of colorectal disease was assessed according to the following colonic segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. RESULTS: Four patients had history of colorectal cancer, and each had undergone partial colonic resection of two segments. Hence, 214 segments were evaluated. Conventional colonoscopy failed in assessment of 127 of 214 potentially visible colonic segments in the 37 patients. MR image quality was rated diagnostic in 35 patients and permitted assessment of 206 of 214 potentially visible segments. Nondiagnostic image quality in two patients was attributed to inadequate distention of prestenotic colonic segments owing to high-grade tumor stenosis. All inflammation- and tumor-induced stenoses and all five polyps identified at conventional colonoscopy in poststenotic segments were correctly detected at MR colonography. However, MR-based assessment of prestenotic segments revealed two lesions suspected of being carcinoma, five polyps, and four segments affected by colitis. CONCLUSION: MR colonography proved reliable in evaluating the majority of colonic segments inaccessible with conventional colonoscopy. The identification of additional disease at MR colonography underscores the need for a second diagnostic step in the setting of incomplete conventional colonoscopy.     

CT colonography in 546 patients with incomplete colonoscopy

PURPOSE: To retrospectively evaluate the positive predictive value (PPV) of computed tomographic (CT) colonography performed in patients who were referred for further examination after incomplete colonoscopy. MATERIALS AND METHODS: This HIPAA-compliant retrospective study was approved by the institutional review board; informed consent was waived. We identified 546 consecutive patients (mean age, 64.1 years; 401 [73.4%] women) who underwent CT colonography after incomplete colonoscopy between November 1999 and December 2002. A retrospective chart review was performed if CT colonography depicted endoscopically nonvisualized lesions 6 mm or greater in diameter. Repeat colonoscopy rate, endoluminal findings, and PPV of CT colonography were determined. Subsequent colonoscopic findings were used as the reference standard. RESULTS: In 72 (13.2%) patients, CT colonography depicted 88 endoscopically nonvisualized lesions 6 mm or greater. Of 11 patients reported to have 12 masses (> or =20 mm), at subsequent colonoscopy, one patient had no mass. Eighteen patients had 23 large (10-19-mm) polyps that they were suspected of having, and 47 patients had 53 medium (6-9-mm) polyps that they were suspected of having. At a median follow-up of 31 months (range, 6-42 months), 45 (63%) of 72 patients underwent follow-up colonoscopy because of their CT colonographic findings. Rates of repeat colonoscopy for masses, large polyps, and medium polyps were 100%, 94%, and 45%, respectively. Per-patient and per-lesion PPVs of CT colonography for masses, large polyps, and medium polyps were 90.9% and 91.7%, 64.7% and 70%, and 33.3% and 30.4%, respectively. CONCLUSION: CT colonography has the potential to become an accepted technique for evaluation of the nonvisualized part of the colon after incomplete colonoscopy, and it can increase the diagnostic yield of masses and clinically important polyps in this part of the colon.