不同口服复方聚乙二醇电解质散方案对老年患者结肠镜检查前肠道准备效果的比较研究

Different Regimens of Polyethylene Glycol Electrolyte Solution in Bowel Preparation before Colonoscopy for Elderly Patients:a Randomized Controlled Study

背景老年患者行电子结肠镜检查前口服药物进行肠道准备时容易出现不良反应大、肠道准备不佳的情况。目的比较3种口服复方聚乙二醇电解质散方案对老年患者结肠镜检查前肠道准备的效果。方法将2016年1月—2018年1月于湖北省肿瘤医院拟行结肠镜检查的221例老年患者采用随机数字表法分为3组,A组(n=74):结肠镜检查当日清晨一次性口服复方聚乙二醇电解质散205.68 g(3袋,溶于3 000 ml温水);B组(n=74):结肠镜检查前1晚及检查当日清晨分2次口服复方聚乙二醇电解质散274.24 g(4袋,溶于4 000 ml温水),每次各口服2 000 ml;C组(n=73)于结肠镜检查前1晚及检查当日清晨分2次口服复方聚乙二醇电解质散274.24 g(4袋,溶于4 000 ml温水),每次各口服2 000 ml,联合莫沙必利分散片5 mg/片,3次/d,口服1 d。3组患者均于服药结束后4 h内行结肠道检查。比较3组患者肠道清洁度、胃肠道不良反应及耐受率、息肉检出率和进镜时间。结果患者肠道清洁度比较:A、B、C组Ottawa评分总分为(3.80±1.22)、(3.88±1.26)、(1.16±0.69)分,B组与A组间无明显差异(P>0.05),C组优于A、B组(P<0.05)。B、C组胃肠道不良反应程度低于A组(P<0.05),B、C组耐受率高于A组(P<0.05)。3组息肉检出率、进镜时间比较,差异无统计学意义(P>0.05)。结论复方聚乙二醇电解质散分次口服不影响老年患者结肠镜检查前肠道清洁效果,但可提高老年患者肠道准备耐受率,减少胃肠道不良反应;复方聚乙二醇电解质散联合莫沙必利口服是老年患者肠道清洁优选方案。

Background Elderly patients are prone to adverse reactions and poor intestinal preparation when taking oral drugs for intestinal preparation before electronic colonoscopy.Objective To compare effects of 3 regimens of polyethylene glycol electrolyte solution on elderly patients for bowel preparation before colonoscopy.Methods Two hundred and twenty-one elderly Patients undergoing colonoscopy from January 2016 to January 2018 in Hubei Cancer Hospital were divided into 3 groups by using random number table method.Group A(n=74):patients took 205.68 g of polyethylene glycol (3 bags) dissolved in 3 000 ml of water at onetime on the morning before receiving colonoscopy.Group B(n=74):patients took 274.24 g of polyethylene glycol(4 bags) dissolved in 4 000 ml of water on the night before and the morning of colonoscopy separately,with 2 000 ml each time.Group C(n=73):patients took 274.24 g of polyethylene glycol(4 bags) dissolved in 4 000 ml water on the night before and the morning of colonoscopy separately,2 000 ml each time,combined with mosapride citrate dispersible tablets,5 mg/tab,tid for one day,only one day.The colonoscopy examination was performed within 4 hours after the end of the taking medicine in all three groups. Intestinal cleaning score,gastrointestinal adverse reaction,detection rate of bowel polyps, the time from the colonoscopy to ileocecal part among 3 groups were compared.Results The total Ottawa score of A,B and C groups were(3.80+1.22),(3.88+1.26) and (1.16+0.69),respectively.Group C had higher score than Group A and Group B(P<0.05),and there was no significant difference between Group A and Group B(P>0.05).Gastrointestinal adverse reaction in Group C and Group B was milder than that of Group A(P<0.05).The intestinal preparation tolerance rate of Group B and Group C was significantly higher than that of group A(P<0.05).There was no significant difference about detection rate of bowel polyps and the time from the colonoscopy to ileocecal part among 3 groups(P>0.05).Conclusion Polyethylene glycol given two times does not affect intestinal cleaning in elderly patients,but can improve their intestinal preparation tolerance rate and reduce their gastrointestinal adverse reaction.Polyethylene glycol combined with Mosapride is an optimal regimen for intestinal cleansing in elderly patients.