静脉麻醉下联合胃肠镜检查顺序对肠道清洁度的影响

The impact of procedural sequence on the quality of bowel preparation in patients with propofol se- dation for same-day bidirectional endoscopy

目的探讨静脉麻醉下联合胃肠镜检查中，先做胃镜对肠道清洁度有无不利影响，为合理检查顺序提供参考。方法单中心随机盲法观察性研究。65例患者随机分成A组（先做胃镜后做结肠镜）和B组（先做肠镜后做胃镜组），根据改良波士顿肠道准备评分标准评估2组肠道清洁度，并比较2组丙泊酚用量、肠镜达盲时间、在操作室总时间、麻醉诱导和恢复时间以及不良事件发生情况。结果2组全结肠清洁度差异无统计学意义（6．724±0．34比6．89±1．50；t=-0．473，P=0．638），而回盲部清洁度差异有统计学意义（1．21±0．54比1．55±0．73；t=-2．158，P=0．035）。2组间操作时间、丙泊酚用量和不良事件发生率等差异无统计学意义。结论静脉麻醉下联合胃肠镜检查时先肠镜后胃镜组回盲部清洁度优于先胃镜后肠镜组，而全结肠清洁度组间差异无统计学意义。对怀疑回盲部病变的患者，若行联合胃肠镜检查，可考虑优先行肠镜检查。

Objective To evaluate the impact of sequence on the quality of bowel preparation in pa- tients with anesthesia for same-day sequential bidirectional endoscopy and propose the optimal procedural se- quence. Methods Single center blinded randomized observational study. Sixty-five patients were random- ized to either the gastroscopy-first group or the colonoseopy-first group. Bowel cleanliness according to Boston bowel preparation scale （BBPS） scores were evaluated, also done the propofol dosage, caeca[ intubation time, procedure duration and complications. Results The BBPS score of entire colon showed no difference （ 6. 72 ± 1.34 vs. 6. 89 ± 1.50, P = 0. 638 ） , but the BBPS of ileal-cecum portion was higher in the colonos- copy-first group （ 1.21 ±0. 54 vs. 1.55 ±0.73, P =0. 035）. The total procedure time, propofol dosage and complications were similar between the two groups. Conclusion The bowel cleanliness of ileal-cecum por- tion in colonoscopy-first group is better than that of gastroscopy-first group during sequential bidirectional en- doscopy in patients with propofol sedation. We propose eolonoscopy first in patients with suspicious ileal-cecum lesion.