个体化肠道准备对肠道准备质量的影响

Effect of tailored bowel preparation on bowel preparation quality

目的 探究应用Dik VK等人建立的肠道准备失败预测模型(Dik VK预测模型)指导个体化肠道准备是否可以提高肠道准备的质量.方法 409例接受肠镜检查的患者随机分为个体化组和对照组,个体化组采用Dik VK预测模型对患者的肠道准备失败的风险进行分级并进行个体化肠道准备:高风险患者采取4 L聚乙二醇电解质散(PEG)的方案进行肠道准备,低风险患者采用常规2 L PEG的方案.在对照组中,所有患者均服用2 L PEG.行结肠镜检查时记录患者肠道准备质量、息肉检出等结果.计量资料采用student-t检验进行分析,计数资料采用Pearsonχ2检验进行分析.结果 7例患者因为个人原因取消结肠镜预约,402例完成结肠镜并纳入ITT分析(个体化组n=202,对照组n=200).个体化组的患者肠道准备成功率为89.6%,高于对照组的77.5%(P=0.002),差异具有统计学意义.个体化组波士顿肠道准备评分(BBPS)总分高于对照组(7.12±1.43 vs 6.64±1.71,P=0.002),各个结肠段分段的评分也高于对照组(P=0.004,P=0.030,P=0.022).个体化组中平均每例患者检出的息肉数目高于对照组(0.74±1.23 vs 0.49±0.87,P=0.020),差异具有统计学意义.两组患者在不良反应发生率、满意度评分方面差异无统计学意义.结论 应用Dik VK预测模型指导个体化肠道准备可以显著提高肠道准备的整体质量.

Objective To investigate the effect of Dik VK predictive model in guiding bowel preparation.Methods A total of 409 patients who underwent colonoscopy were randomly assigned to tailored group and control group.Patients in the tailored group were assessed with Dik VK predictive model.Those with high risk of inadequate bowel preparation were prescribed a regimen of 4L polyethylene glycol(PEG),while those with low risk were given a normal dose of 2L PEG.Patients in the control group were prescribed a normal dose of 2L PEG.The bowel preparation quality and poly de-tection rate were recorded during colonoscopy.Continuous variables were analyzed using student-t test and categorical variables were analyzed using Pearsonχ2 test.Results Seven patients cancelled colonoscopy appointment for personal reasons and finally 402 patients received colonoscopy and were included into ITT analysis(202 cases in tailored group,200 cases in control group).The tailored group had higher adequate bowel preparation rate than the control group(89.6%vs 77.5%,P=0.002),higher total Boston Bowel Preparation Score(BBPS)(7.12±1.43 vs 6.64±1.71,P=0.002),higher scores for the separate three colon segments(P=0.004,P=0.030,P=0.022),and larger number of polyps detected per patient(0.74±1.23 vs 0.49±0.87,P=0.020).There were no differences in adverse reactions and degree of satisfaction between the two groups.Conclusion Tailored bowel preparation guided by the predictive model for inadequate bowel preparation significantly improves the overall quality of bowel preparation.