炎症性肠病患者改良肠道准备方式探讨

Exploration of an improved bowel preparation for inflammatory bowel disease patients

目的 探究对炎症性肠病(IBD)患者改良肠道准备方式以提高肠镜检查质量.方法 采用前瞻性研究方法,将2016年12月至2017年3月期间于邵逸夫医院炎症性肠病中心进行结肠镜检查的炎症性肠病患者,按检查时间顺序分为对照组和试验组.对照组在肠道准备清肠前1d无渣饮食;试验组早中餐无渣饮食、晚餐口服肠内营养液.采用Boston肠道准备评价量表(BBPS)进行肠道清洁度评价.结果 114例IBD患者入组,对照组和试验组各57例.两组患者左半结肠BBPS评分均分别高于同组的右半结肠评分(对照组:2.77±0.54比2.28±0.80,P=0.0002;试验组:2.91±0.28比2.63±0.59,P=0.0015).与对照组相比,试验组的右半结肠BBPS评分(2.63±0.59比2.28±0.80,P=0.009)、横结肠BBPS评分(2.98±0.13比2.81 ±0.58,P=0.028)和总BBPS评分(8.53±0.66比7.86±1.56,P=0.004)更高.两组患者间的左半结肠BBPS评分差异无统计学意义.研究过程中无明显不良反应和并发症发生.结论 试验组患者的肠道准备清洁效果较对照组更好,且主要体现在右半结肠和横结肠.这提示如需要观察全结肠,清肠前1d早中餐无渣饮食、晚餐口服肠内营养液会具有更好的清肠效果;如只需观察左半结肠,清肠前1d常规无渣饮食即可.

Objective To improve the quality of colonoscopy examination by exploring an improved pre-preparation method for patients with inflammatory bowel disease (IBD).Methods A prospective study was carried out.Patients with IBD undergoing colonoscopy at the Center of Inflammatory Bowel Diseases of Sir Run Run Shaw Hospital between December 2016 and March 2017 were divided into control group and trial group according to the order of examination time.The control group received no slag diet 1 day before bowel preparation,and the trial group received no slag diet for breakfast and lunch and oral enteral nutrition solution for dinner.The bowel cleanliness was assessed by the Boston bowel preparation scale (BBPS).Results A total of 114 IBD patients were enrolled with 57 cases in each control and trial group.The BBPS scores in the left hemicolon of both groups were higher than those in the right hemicolon in the same group (control group:2.77 ± 0.54 vs.2.28 ± 0.80,P =0.0002;trial group:2.91 ± 0.28 vs.2.63 ± 0.59,P =0.0015).Compared with control group,trial group had higher BBPS score of right hemicolon (2.63 ± 0.59 vs.2.28 ± 0.80,P =0.009),higher BBPS score of transverse colon (2.98 ±0.13 vs.2.81 ±0.58,P=0.028) and higher total BBPS score (8.53±0.66 vs.7.86± 1.56,P=0.004).There was no statistically significant difference in BBPS score of left hemicolon between two groups.No obvious adverse reactions and complications occurred during the study.Conclusions The bowel preparation cleansing effect of the trial group is better than that of the control group,which is mainly present in right hemicolon and transverse colon.It suggests that for whole colon examination,no slag diet plus oral enteral nutrition solution dinner 1 day before the bowel cleansing will have a better effect,and if for left hemicolon examination only,normal no slag diet 1 day before the bowel cleansing is suitable.