基于波士顿肠道准备评分标准与肠镜检查前肉眼粪便观察法一致性研究

Pre-colonoscopic visual faecal observation versus colonoscopic Boston bowel preparation score:A consistency study in assessment of bowel cleanliness

目的探讨内镜下波士顿肠道准备评分判断与肠镜检查前肉眼粪便观察法评价肠道清洁度的一致性,以便指导临床肠道准备工作。方法2018年9月至2019年6月,采用便利抽样法,选取在广州市某三级甲等综合医院消化内科住院行结肠镜检查的患者150例作为研究对象,肠镜检查前按照统一的肠道准备方案给予复方聚乙二醇电解质散口服进行清洁肠道,检查前先由护士采用肉眼观察法观察排泄物清亮度以评价肠道清洁度,之后由内镜医师在肠镜检查时用波士顿肠道准备评价量表进行肠道清洁度评价。结果145例患者完成研究。肉眼观察法肠道准备清洁度为93.10%,内镜直视下肠道准备清洁度为88.28%,两种评价方法在判断肠道准备一致性无显著差异(P>0.05),肉眼观察法判断肠道准备的敏感性为96.10%,特异性为29.41%,阳性预测值为91.11%,阴性预测值为50.00%,Kappa值为0.310,P<0.001,表明两种评价方法具有较好的一致性。结论肉眼粪便观察评价法具有敏感性高,特异性低,阳性预测值高,阴性预测值较低的特点,认为可作为肠镜检查前肠道清洁的初步评价方法,基本能满足内镜下肠道清洁的要求。对于肠道肿瘤、炎症性肠病等未能达到肠道清洁度标准者值得进一步探讨。

Objective To investigate the consistency between colonoscopic Boston bowel preparation score and the bowel cleanliness evaluated by pre-endoscopy naked eye faecal observation,so as to provide a guidance on bowel preparation.Methods From September 2018 to June 2019,convenience sampling method was used to select 150 inpatients who underwent colonoscopy in the Department of Gastroenterology of a tertiary hospital in Guangzhou as the research objects.Before colonoscopy,the compound polyethylene glycol electrolyte powder was taken orally according to the bowel preparation plan for cleaning the colorectum.Before the colonoscopic examination,the naked eye observation method by nurses was used to observe the transparency of the excreta to evaluate the cleanliness of colorectum.Then the colorectal cleanliness was evaluated by endoscope by the operator using the Boston bowel preparation assessment scale(BBPS)during colonoscopy.Results A total of 145 patients completed the study.The cleanliness of bowel preparation was 93.1%with the naked eye observation and 88.27%with colonoscopy.There was no significant difference between the two assessment methods in judging the effectiveness of bowel preparation(P<0.05).The sensitivity of naked eye observation in judging bowel preparation was 96.10%with a 29.41%of specificity.The positive predictive value was 91.11%,and the negative predictive value was 50%(Kappa=0.310,P<0.001).Conclusion The naked eye observation and evaluation method for bowel preparation has advantages in high sensitivity,low specificity,high positive predictive value and low negative predictive value.It can be used as a preliminary evaluation method for cleanliness of colorectum before colonoscopy.