老年人大肠镜检查前肠道准备的优化

Optimization of bowel preparation before colonoscopy in the elderly

目的观察老年人在大肠镜检查前不同的肠道准备方法及肠道准备时添加肠内营养制剂，对肠道清洁度、肠道准备的安全性的影响，以期建立更适用于老年患者的肠道准备方法。方法将120例老年患者随机分为4组，每组各30例，分别在肠道准备时给予A组：聚乙二醇（PEG）电解质，B组：PEG＋肠内营养液，C组：硫酸镁，D组：硫酸镁＋肠内营养液，记录肠道清洁度、肠道准备后体质量、血压、血糖变化及心脑血管事件发生率，并作相互比较。结果4种方法进行肠道准备后，清洁肠道的总有效率均在80％以上，4组清洁肠道有效率相似（P〉0．05）；4组病例在肠道准备前后均发生体质量、心率、收缩压、舒张压及空腹血糖改变，服用营养液的B、D两组变化幅度小于不加营养液的A、C组（P〈0．05）；加用营养液的B、D组无低血糖、休克、头晕、心绞痛及呕吐发生，无病例需要静脉补充液体，明显好于不补充营养液的A、C组。结论老年患者肠镜前行肠道准备时加服肠内营养液降低不良事件的发生、不影响肠道清洁度，是适用于老年患者肠道准备的安全方法。

Objective To study the bowel cleanliness and safety in the elderly with different ways of bowel preparation before colonoscopy. Methods A total of 120 patients were divided randomizely into 4 groups （n=30）. For bowel preparation, patients in the first group（A group） received polyethylene glycol electrolytes （PEG）; the second group（B group） received PEG and 500ml enteral nutrient; the third group（C group） took magnesium sulfate （MgSO4）; the forth group（D group） were given MgSO4 and 500 ml enteral nutrient. Bowel preparation quality of every patient was monitored, the change of body mass （BM）, blood pressure （BP）, fasting blood glucose （FBG）, side effects on heart or brain were collected and analyzed. Results The total effective rate of bowel preparation was more than 80%, the intestinal cleanliness efficiency of each group was similar （P 〉 0.05）; The patients in group B and group D who took enteral nutrient got less change in BM, FBG, BP, heart rate after bowel preparation than those in group A and group C （P 〈 0.05）. No hypoglycemia, shock, dizziness, angina, or vomiting occurred in group B and D with the addition administration of nutrient solution, no patient required intravenous fluids administration, which was significantly better than the cases in group A and C. Conclusion Taking enteral nutrient for bowel preparation before colonoscopy can reduce patient＇s side effect and keep the bowel preparation quality, it is a safe way for bowel preparation in the elderly patients.