使用磷酸钠盐口服液进行肠道准备的效果观察

目的 探讨磷酸钠盐口服液作为清肠剂在电子结肠镜检查患者进行肠道准备中应用的效果.方法 将120例行电子结肠镜检查的患者按抽签法随机分为磷酸钠盐组与聚乙二醇组各60例,磷酸钠盐组于检查当日上午8:00口服磷酸钠盐原液45 mL加温开水750 mL稀释后30 min内喝完,11:00按同样的方法重复口服1次;聚乙二醇组于检查当日上午9:00将聚乙二醇电解质散137.12 g倒入2 000 mL温开水中,充分溶解后首次服用1 000 mL,1 h内喝完,全部2 000 mL溶液在1.5～2.0 h内喝完.比较两组患者不良反应发生率及清肠效果.结果 磷酸钠盐组恶心、呕吐、腹痛、腹胀等不良反应发生率低于聚乙二醇组(P＜0.05),肠道清洁效果优于聚乙二醇组(P＜0.05).结论 采用磷酸钠盐口服液进行肠道清洁效果显著,不良反应较少,值得临床推广.     

磷酸钠盐溶液用于术前肠道准备时服药时间的研究

[目的]观察磷酸钠盐口服溶液在泌尿外科术前肠道准备时口服药物的最佳时间。[方法]选择泌尿外科择期手术病人360例,随机分为观察组和对照组,应用磷酸钠盐口服溶液45mL稀释后服用进行肠道准备,观察组于术前1d16:00服药,对照组于术前1d 19:00服药。观察两组肠道准备的效果及服药前、后病人血液生化指标的动态变化。[结果]观察组肠道清洁满意率为95.0%,对照组肠道清洁满意率为80.0%,两组比较差异有统计学意义(P0.01);服药后1h除血磷、血钠离子一过性升高且在12h内自行恢复外,其他生化指标均未发生明显改变,未见有肝肾功能损害。[结论]术前1d16:00口服磷酸钠盐口服溶液进行肠道准备安全、有效,病人易于接受,副反应发生率低,清洁效果好,明显优于术前1d19:00服药行肠道准备者。     

磷酸钠盐溶液用于术前肠道准备时服药时间的研究

[目的]观察磷酸钠盐口服溶液在泌尿外科术前肠道准备时口服药物的最佳时间。[方法]选择泌尿外科择期手术病人360例,随机分为观察组和对照组,应用磷酸钠盐口服溶液45mL稀释后服用进行肠道准备,观察组于术前1d16：00服药,对照组于术前1d 19：00服药。观察两组肠道准备的效果及服药前、后病人血液生化指标的动态变化。[结果]观察组肠道清洁满意率为95.0%,对照组肠道清洁满意率为80.0%,两组比较差异有统计学意义（P〈0.01）;服药后1h除血磷、血钠离子一过性升高且在12h内自行恢复外,其他生化指标均未发生明显改变,未见有肝肾功能损害。[结论]术前1d16：00口服磷酸钠盐口服溶液进行肠道准备安全、有效,病人易于接受,副反应发生率低,清洁效果好,明显优于术前1d19：00服药行肠道准备者。     

口服磷酸钠盐与电解质液在结肠镜检查肠道准备中的效果比较

目的比较口服磷酸钠盐与电解质液在结肠镜检查中清理肠道的效果、安全性及患者耐受性。方法将320例需行结肠镜检查的患者顺序交叉入组,分为试验组160例和对照组160例,试验组采用口服磷酸钠盐法清理肠道。对照组采用口服蓖麻油加本院自制的电解质液清理肠道。制作统一问卷调查表,记录患者对肠道准备的耐受性和不良反应,以及对肠道清理效果的评价。结果试验组对肠道准备的耐受性明显优于对照组(P<0.05)。试验组肠道准备清洁度高于对照组,但无显著性差异(P>0.05)。结论磷酸钠盐清洁肠道安全、可靠,患者不良反应轻、口感好、服药容易、清肠效果满意。     

磷酸钠盐口服液联合西甲硅油在妇科腹腔镜术前肠道准备中的应用

目的观察磷酸钠盐口服液联合西甲硅油在妇科腹腔镜术前肠道准备中的应用效果。方法将150例患者分成观察组和对照组各75例,对照组单纯服用磷酸钠盐口服液,观察组磷酸钠盐口服液与西甲硅油联用,观察两组患者的肠道清洁程度和不良反应发生情况。结果观察组肠道清洁度优59例、良15例、差1例,对照组优34例、良27例、差14例;观察组腹胀、腹痛不良反应发生率低于对照组。结论磷酸钠盐口服液联用西甲硅油在妇科腹腔镜术前肠道准备中应用效果好。     

结肠镜检查采用不同药物行肠道准备的效果比较

目的比较不同药物用于结肠镜检查肠道准备的效果。方法行结肠镜检查和治疗患者120例,随机分为A组和B组,各60例。A组口服磷酸钠盐口服液行肠道准备。B组口服甘露醇行肠道准备。比较两组内镜下的肠道清理效果、耐受性和顺应性。结果A组肠道清洁度明显高于B组（P〈0．05）,A组口服清肠剂后耐受性和顺应性优于B组（P〈0．05）。结论磷酸钠盐口服液是安全、方便、清肠效果理想的药物。     

分次或单次口服磷酸钠盐清肠液在小儿肠镜检查前肠道准备中的效果观察

[目的]观察分次或单次口服磷酸钠盐清肠液在小儿肠镜检查前肠道准备中的效果。[方法]将100例拟行结肠镜检查患儿随机分为观察组和对照组,每组50例,对照组给予单次口服磷酸钠盐清肠液,观察组给予分次口服磷酸钠盐清肠液,比较两组肠道清洁度、耐受性及不良反应发生率。[结果]观察组患儿肠道清洁度显著高于对照组(P0.05)、耐受性显著优于对照组(P0.05)、不良反应发生率显著低于对照组(P0.05)。[结论]分次口服磷酸钠盐清肠液进行小儿肠道准备,可降低不良反应发生率,提高患儿耐受性,获得更好的肠道清洁效果。     

磷酸钠盐溶液在老年便秘患者结肠镜检查前肠道准备中的应用

目的:探讨口服磷酸钠盐溶液在老年便秘患者结肠镜检查前肠道准备中的应用及临床效果。方法:将63例行结肠镜检查的老年便秘患者,按入院先后顺序随机分为观察组32例和对照组31例,观察组给予磷酸钠盐口服溶液,对照组口服50%硫酸镁溶液;比较两组患者服药后肠道清洁效果及耐受性。结果:观察组肠道准备成功率明显高于对照组(P0.05)。结论:对老年便秘患者应用磷酸钠盐口服溶液,可明显提高肠道准备成功率,值得临床推广应用。     

聚乙二醇电解质溶液在结肠镜检查前肠道准备中的应用与护理

目的研究口服聚乙二醇电解质溶液2 000 ml在肠镜检查前肠道准备中的效果和安全性。方法将100例行结肠镜检查的病人随机分为实验组和对照组,实验组口服聚乙二醇电解质溶液清肠,对照组口服电解质溶液加蓖麻油清肠。观察服药后的排便次数和性状,肠道清洁程度,病人服药后的反应,肠腔内气泡情况。服药前、结肠镜检查结束时分别测心率、血压,进行血、尿常规检查和电解质测定。结果实验组肠道准备时间较对照组明显缩短,两组差异有显著意义;两组清洁肠道有效率均达100%,无明显差异;不良反应实验组明显少于对照组;在耐受性方面,实验组优于对照组。结论口服聚乙二醇电解质溶液清洁肠道效果佳,安全性好,可替代我科传统的电解质溶液加蓖麻油清肠方法。     

老年妇科手术患者术前口服磷酸钠盐的临床观察

目的：研究老年妇科手术患者术前口服磷酸钠盐对老年妇科手术术前肠道准备的效果。方法：设对照组和实验组,对照组采用传统清洁灌肠方法。实验组采用术前1d7：00与19：00口服磷酸钠盐口服液。结果：实验组与对照组的肠道洁度、不良反应及胃肠功能恢复情况比较,P均〈0．01,差异显著。结论：口服磷酸钠盐口服液清洁肠道效果好,适合老年妇科手术术前灌肠准备。     

改良磷酸钠口服肠道灌洗剂的应用研究

目的：对磷酸钠液进行改良,旨在改善其口感,并观察清洁效果及恶性循环 以评价其实用价值。方法：选择１９９７年３～８月拟行结肠镜检的门诊及住院患者６０例,随机分为两组,与电解质液对照,盲法评定清洁效果,以问卷方式了解其口感、耐受性和不良反应。结果：改良后磷酸钠液的口感得到明显好转且化于电解质液（Ｐ〈０．０５）;其不良反应、耐受性显著好于对照（Ｐ〈０．００５,０．０２５）,耐受良好者分别占９０．００％和     

恒康正清在结肠镜检查前肠道准备中的应用

目的比较硫酸镁、恒康正清（复方聚乙二醇电解质散）两种灌洗药在结肠镜检查前肠道准备中的效果。方法采用随机分组方法将104例患者随机分为硫酸镁组和恒康正清组,以问卷法和观察法收集资料,观察两组的使用效果。结果恒康正清组比硫酸镁组患者对肠道准备的接受程度好,肠道准备过程中患者不适症状轻,肠道清洁效果优,两组比较差异显著,具有统计学意义（P〈0．05）;在结肠镜检查前后的血液电解质、血生化指标方面,两组的差异无统计学意义（P〉0．05）。结论恒康正清作为结肠镜检查术前肠道准备用药,其效果优于硫酸镁。     

不同清洁肠道药物降低肝癌术后高胆红素血症发生率的临床研究

目的探讨可降低原发性肝癌术后高胆红素血症发生率的术前清洁肠道药物。方法将240例原发性肝癌患者随机分为A、B、C、D 4组,每组60例,分别采用25%硫酸镁(A组)、磷酸钠盐口服溶液(B组)、聚乙二醇电解质散(C组)、乳果糖口服溶液(D组)作为口服清洁肠道药物,于术后第1、3日检测血清胆红素值,比较各组高胆红素血症的发生率。结果使用4种药物的肠道清洁程度和术后肠功能恢复时间的差异无统计学意义(P>0.05);A组、C组高胆红素血症发生率显著低于B组、D组,差异有统计学意义(P<0.001);C组药物口感、接受度明显优于A组(P<0.05)。结论术前应用硫酸镁和聚乙二醇电解质散清洁肠道均可降低原发性肝癌术后高胆红素血症的发生率,聚乙二醇电解质散的口感和患者的接受度优于硫酸镁。     

Saline lavage: a rapid, safe, effective method of whole-gut irrigation for bowel preparation

The standard preparation for cleansing the colon usually involves dietary restrictions, purgatives, and enemas. This is time-consuming, often uncomfortable, and at times unsuccessful. This study of 37 patients examines the efficacy of saline lavage as an alternative method for cleansing the bowel. Isotonic sodium chloride solution is passed into the gut via a small nasogastric tube. The flush is continued for about four hours, until clear effluent is passed per anus. There were no significant complications or variations in weight or serum electrolyte values. Patient acceptance was generally excellent. In our opinion, this rapid bowel preparation consistently provided a clean bowel so that both bowel preparation and colonscopy were accomplished the same day.     

Differences in clinical chemistry values according to the use of two laxatives for colonoscopy

Objectives

Polyethylene glycol–electrolyte lavage solutions (PEG–ELSs) and sodium phosphate formulations (NaPs) are two major colon cleansing laxatives used in preparation for endoscopic examinations of the gastrointestinal tract. PEG–ELSs are osmotically balanced preparations, whereas NaPs are hyperosmotic purgatives. This study aimed to evaluate the effects of these two laxatives on routine chemistry tests.

Design and methods

We retrospectively reviewed 9366 clinical records of patients who had health checkups with or without colonoscopy from July 2010 to June 2011. We compared the values of 19 clinical chemistry parameters in the NaPs group (n = 3239) and the PEG–ELSs group (n = 1279) with those of controls (without colonoscopy, n = 4848).

Results

Compared with controls, the NaPs group had higher mean values of inorganic phosphate, sodium, chloride, creatinine, total protein, AST, and ALT, and lower mean values of calcium and potassium, exceeding acceptable biases. Notably, inorganic phosphate showed the largest % bias (51.14%). In the PEG–ELSs laxative group, higher mean values of inorganic phosphorus, creatinine, uric acid, AST, and total bilirubin and a lower mean value of potassium were observed compared with controls, exceeding acceptable biases. The effects of NaPs on inorganic phosphate, calcium, and electrolyte levels exceeded those of PEG–ELSs.

Conclusions

PEG–ELSs rather than NaPs are recommended as the first choice for bowel preparation, taking safety concerns and the reliability of laboratory values into account. Blood chemistry data from blood samples drawn after the ingestion of laxatives for colonoscopy should be interpreted with caution.     

Premedication, preparation, and surveillance

During the last two years, the well-known positive role of benzodiazepines (midazolam and diazepam) in conscious sedation, both in adults and pediatric patients, has been confirmed by several studies. However, problems concerning the role of sedation and analgesia in nonoperative endoscopy are still a matter of debate. Particular attention has focused on attempts to identify the "ideal candidate" for conscious sedation, and on the importance of providing patients with information before the procedure, which should be matched to each patient's style of coping. Before detailed information about a medical procedure is given blindly, the clinician should investigate whether such information will benefit or adversely affect the patient receiving it. An important aspect of the sedation procedure is the prevention of hypoxia and cardiopulmonary complications. Recent endoscopic experience has provided little additional information concerning the well-known risk of oxygen desaturation during conscious sedation. Performing endoscopy in sedated patients reduces, but does not eliminate, the risk of hypoxia. Some independent variables capable of predicting severe desaturation have been recognized, such as basal SaO2 < 95%, respiratory disease, more than one attempt needed for intubation, emergency procedure, and an American Society of Anesthesiologists score of III or IV. As far as preparation is concerned, some light has been cast by a meta-analysis of available studies concerning the role of sodium phosphate and polyethylene glycol electrolyte lavage solution (PEG-ELS). The former preparation has been found to be as effective and less costly compared with the latter. In particular, sodium phosphate may be preferable in patients without cardiovascular or renal co-morbidity, and in those with a tendency to develop nausea or bloating.     

Gentamicin effects on urinary electrolyte excretion in healthy subjects

BACKGROUND: Symptomatic hypomagnesemia, hypocalcemia, and hypokalemia caused by renal electrolyte wasting occasionally develop in patients treated with aminoglycosides. This phenomenon has been attributed to aminoglycoside tubular injury. However, rats administered a single dose of gentamicin show immediate dose-related calcium and magnesium renal wasting without sodium or potassium wasting days before other evidence of tubular dysfunction or structural injury can be shown. The mechanism is undefined but transient and is not dependent on the presence of parathyroid hormone. OBJECTIVE: To determine whether gentamicin administration to humans causes renal electrolyte wasting. DESIGN: Five healthy volunteers ingested a 400-mg calcium, 100-mEq sodium diet for 1 week before the study. After a 90-minute baseline period, 5 mg/kg gentamicin was administered intravenously over 30 minutes. Urine and serum were collected for 5 hours after gentamicin administration. RESULTS: Peak serum gentamicin levels ranged from 12.8 to 20.6 microg/mL. There was no change in serum electrolytes. The urinary fractional calcium excretion rose from a baseline of 1.8% +/- 0.5% to 6.8% +/- 1.4% (P < .01), and the magnesium fractional excretion rose from 3.4% +/- 0.8% to 11.8% +/- 6.4% (P = .03). These effects were transient. Gentamicin caused no change in renal excretion of sodium, potassium, or phosphate. CONCLUSIONS: Gentamicin administered at the standard clinical dose causes immediate and transient renal calcium and magnesium wasting in normal humans. The mechanism of gentamicin-associated urinary magnesium wasting and calciuria is undefined. However, the pattern of electrolyte excretion after gentamicin administration suggests that the site of action of these gentamicin effects is the distal convoluted tubule.     

Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study

Introduction

Electrolyte disorders are an important cause of ventricular and supraventricular arrhythmias as well as various other complications in the intensive care unit. Patients undergoing cardiac surgery are at risk for development of tachyarrhythmias, especially in the period during and immediately after surgical intervention. Preventing electrolyte disorders is thus an important goal of therapy in such patients. However, although levels of potassium are usually measured regularly in these patients, other electrolytes such as magnesium, phosphate and calcium are measured far less frequently. We hypothesized that patients undergoing cardiac surgical procedures might be at risk for electrolyte depletion, and we therefore conducted the present study to assess electrolyte levels in such patients.

Methods

Levels of magnesium, phosphate, potassium, calcium and sodium were measured in 500 consecutive patients undergoing various cardiac surgical procedures who required extracorporeal circulation (group 1). A total of 250 patients admitted to the intensive care unit following other major surgical procedures served as control individuals (group 2). Urine electrolyte excretion was measured in a subgroup of 50 patients in both groups.

Results

All cardiac patients received 1 l cardioplegia solution containing 16 mmol potassium and 16 mmol magnesium. In addition, intravenous potassium supplementation was greater in cardiac surgery patients (mean ± standard error: 10.2 ± 4.8 mmol/hour in cardiac surgery patients versus 1.3 ± 1.0 in control individuals; P < 0.01), and most (76% versus 2%; P < 0.01) received one or more doses of magnesium (on average 2.1 g) for clinical reasons, mostly intraoperative arrhythmia. Despite these differences in supplementation, electrolyte levels decreased significantly in cardiac surgery patients, most of whom (88% of cardiac surgery patients versus 20% of control individuals; P < 0.001) met criteria for clinical deficiency in one or more electrolytes. Electrolyte levels were as follows (mmol/l [mean ± standard error]; cardiac patients versus control individuals): phosphate 0.43 ± 0.22 versus 0.92 ± 0.32 (P < 0.001); magnesium 0.62 ± 0.24 versus 0.95 ± 0.27 (P < 0.001); calcium 1.96 ± 0.41 versus 2.12 ± 0.33 (P < 0.001); and potassium 3.6 ± 0.70 versus 3.9 ± 0.63 (P < 0.01). Magnesium levels in patients who had not received supplementation were 0.47 ± 0.16 mmol/l in group 1 and 0.95 ± 0.26 mmol/l in group 2 (P < 0.001). Urinary excretion of potassium, magnesium and phosphate was high in group 1 (data not shown), but this alone could not completely account for the observed electrolyte depletion.

Conclusion

Patients undergoing cardiac surgery with extracorporeal circulation are at high risk for electrolyte depletion, despite supplementation of some electrolytes, such as potassium. The probable mechanism is a combination of increased urinary excretion and intracellular shift induced by a combination of extracorporeal circulation and decreased body temperature during surgery (hypothermia induced diuresis). Our findings may partly explain the high risk of tachyarrhythmia in patients who have undergone cardiac surgery. Prophylactic supplementation of potassium, magnesium and phosphate should be seriously considered in all patients undergoing cardiac surgical procedures, both during surgery and in the immediate postoperative period. Levels of these electrolytes should be monitored frequently in such patients.     

口服泻药结合甘油剂灌肠在提高糖尿病患者肠道清洁度中的作用

目的探讨口服聚乙二醇电解质散结合甘油剂灌肠在提高糖尿病患者肠道清洁度中的作用效果。方法将110例行结肠镜检查的糖尿病患者随机分为实验组和对照组,每组各55例。在结肠镜检查前,给予对照组患者口服聚乙二醇电解质散清洁肠道,实验组在此基础上采用甘油剂进行灌肠。比较两组患者肠道清洁度的差异。结果实验组患者肠道清洁度(96.4%)优于对照组(78.2%),两组比较,χ2=8.91,P<0.05,差异具有统计学意义。结论口服聚乙二醇电解质散结合甘油剂灌肠的方法,可提高糖尿病患者的肠道清洁度,使结肠镜检查能顺利进行,值得临床推广应用。     

纯净水加氯化钠在洗胃中的临床应用

目的：观察纯净水加氯化钠在口服药物中毒中的临床应用效果。方法：将248例口服中毒患者随机分为观察组（127例）和对照组（121例）。对照组以纯净水洗胃,观察组以纯净水加氯化钠（每桶纯净水10L加氯化钠90g,相当于0．9％氯化钠）洗胃,两组均用自制特殊加温装置加热到36℃。观察洗胃前后的平均动脉压、心率、血常规、血钠和血钾情况,并留剩余洗胃液送培养。结果：洗胃后两组血清钠浓度、平均动脉压水平的差异有统计学意义（P〈0．01）。剩余洗胃液送培养结果,对照组大肠杆菌超标,观察未见超标大肠杆菌生长。结论：纯净水水源充足,符合饮用水卫生标准,加入一定量的氯化钠后,接近生理盐水的浓度,能避免洗胃时出现的低钠血症及血压下降现象,减少院内交叉感染。