低容量聚乙二醇电解质散分次服用时间对儿童结肠镜检查肠道准备影响的前瞻性对比研究

Prospective comparison of different admission time of polyethylene glycol-electrolyte lavage solution regimens for bowel preparation in pediatric colonoscopy

目的探讨低容量聚乙二醇电解质散分次服用时间对儿童结肠镜检查肠道准备的影响,以寻求优化的服药方案。方法2016年7月至2017年7月,在上海儿童医学中心消化内科行麻醉下结肠镜检查的3~18岁患儿,先经纳入和排除标准确定研究对象,后使用方便抽样方法进行分组,其中2016年7月1日至2016年12月31日的入院患儿纳入对照组(n=64),2017年1月1日至2017年7月31日的入院患儿纳入干预组(n=97)。对照组肠道准备采用术前二日19∶00和术前一日19∶00的分次服药方式,干预组采用术前一日19∶00和术日4∶30的分次服药方式,先后两次服药剂量同,总剂量依据患儿年龄确定。主要观察肠道清洁度和术中是否需要灌肠,次要观察指标包括服药依从性、接受度和耐受度,以上指标2组间比较使用卡方检验,检验水准统一为α=0.05。 结果2组在性别构成、平均年龄、适应证构成及服药依从性方面差异均无统计学意义(P均>0.05)。肠道清洁合格率干预组明显高于对照组[93.8%(91/97)比42.2%(27/64)],差异有统计学意义(χ^2=52.502,P=0.000);术中灌肠率干预组明显低于对照组[17.5%(17/97)比96.9%(62/64)],差异有统计学意义(χ^2=97.145,P=0.000)。服药接受度方面,干预组易接受率高于对照组[51.5%(50/97)比39.1%(25/64)],但差异无统计学意义(χ^2=0.215,P=0.643)。服药耐受度方面,干预组服药后无症状率高于对照组[36.1%(35/97)比14.1%(9/64)],差异有统计学意义(χ^2=14.062,P=0.007);恶心发生率低于对照组[1.0%(1/97)比6.3%(4/64)],但差异无统计学意义(χ^2=3.490,P=0.082);呕吐发生率高于对照组[29.9%(29/97)比29.7%(19/64)],但差异无统计学意义(χ^2=0.001,P=1.000);腹痛发生率低于对照组[25.8%(25/97)比43.8%(28/64)],差异有统计学意义(χ^2=5.643,P=0.025);肛门不适发生率高于对照组[7.2%(7/97)比6.3%(4/64)],但差异无统计学意义(χ^2=0.057,P=1.000)。结论对于儿童结肠镜检查前的肠道准备,术前一日19∶00和术日4∶30的分次服药方案,其肠道准备效果优于术前二日19∶00和术前一日19∶00的分次服药方案,并且可以有效减少服药后腹痛的发生。

Objective To evaluate effects of different admission time of polyethylene glycol-electrolyte lavage solution (PEG-ELS) regimens on bowel preparation before colonoscopy in children and to seek better regimens. Methods Children (3-18 years old) receiving colonoscopy under sedation in Shanghai Children′s Medical Center from July 2016 to July 2017 were prospectively enrolled in the control group (n=64) and intervention group (n=97), according to convenience sampling. Children in the control group on the two-day regimen took PEG-ELS at 7 pm for 2 consecutive nights before colonoscopy, and those in the intervention group took PEG-ELS at 7 pm the day before colonoscopy and 4∶30 am on the day of colonoscopy. All children had the same low-fiber diet for 3 days before colonoscopy. Main outcome measures were intestinal clearance and enema rate. Secondary outcome measures were medication compliance, acceptance and tolerance. The Chi-square test was used to analyze the relevant indicators between the two groups. Results There were no significant differences in gender composition, mean age, indication composition and medication adherence between the two groups (P>0.05). The intestinal clearance rate was significantly higher in the intervention group than that in the control group [93.8% (91/97) VS 42.2% (27/64)] with significant difference (χ^2=52.502, P=0.000). The enema rate was significantly lower in the intervention group[17.5% (17/97) VS 96.9% (62/64)] with significant difference (χ^2=97.145, P=0.000). In terms of medication acceptance, the acceptance rate of the intervention group was higher[51.5% (50/97) VS 39.1% (25/64)] with no significant difference (χ^2=0.215, P=0.643). In terms of medication tolerance, the asymptomatic rate of the intervention group was higher than that of the control group [36.1% (35/97) VS 14.1% (9/64)], and the difference was statistically significant (χ^2=14.062, P=0.007). The incidence of nausea was lower in the intervention group [1.0% (1/97) VS 6.3% (4/64)], with no significant difference (χ^2=3.490, P=0.082). The incidence of vomiting was higher in the intervention group [29.9% (29/97) VS 29.7% (19/64)] with no significant difference (χ^2=0.001, P=1.000). The incidence of abdominal pain was lower in the intervention group [25.8% (25/97) VS 43.8% (28/64)] with significant difference (χ^2=5.643, P=0.025). The incidence of anal discomfort was higher in the intervention group [7.2% (7/97) VS 6.3 %(4/64)], with no significant difference (χ^2=0.057, P=1.000). Conclusion The one-day split-dosage PEG-ELS regimen has better efficacy and safety in bowel preparations, and it can effectively reduce the incidence of abdominal pain.