成人结肠镜检查前肠道准备的最佳证据总结

Best Evidence Summary for Bowel Preparation Before Colonoscopy in Adults

目的检索分析并总结成人结肠镜检查前肠道准备的相关证据,为临床护理人员、管理者对结肠镜检查的患者进行最佳的肠道准备提供科学依据,同时也为患者及家属提供参考依据。方法应用循证的方法,针对成人结肠镜检查前的肠道准备提出问题,并检索近5年内的相关研究,包括指南、临床决策、证据总结(evidence summary,ES)、最佳实践信息册(best practice Information sheet,BPIS)、推荐实践(recommendation practice,RP)、系统评价(systematic review,SR),检索数据库依次为:Up To Date、BMJ Best Practice、英国国家卫生与临床优化研究所指南网(National Institute for Health and Care Excellence,NICE)、澳大利亚JBI循证卫生保健中心证据总结数据库、Cochrane数据库、医脉通指南网、PubMed、CINAHL数据库、中国知网。采用英国2009年更新的《临床指南研究与评价系统》(Appraisal of Guidelines for Research and Evaluation InstrumentⅡ,AGREEⅡ)、JBI的文献质量评价工具对各类研究进行文献质量评价及证据级别评定。结果最终纳入10篇文献,其中临床决策2篇,指南4篇,证据总结2篇,系统评价2篇。结合临床护理人员的判断,汇总出17条结肠镜检查前肠道准备的证据,包括肠道准备的宣教、饮食指导、用药时机、肠道清洁剂的选择及服用方法、辅助药物及特殊患者的肠道准备等方面。结论最佳的肠道准备方案仍需要根据医疗机构的实际条件、医护人员的临床经验及患者需求相结合来共同制定。

Objective To retrieve,analyze and summarize available evidence on bowel preparation before colonoscopy in adults,and to provide reference for clinical nurses to carry out standardized bowel preparation.Methods Nursing problems of bowel preparation before colonoscopy in adults were raised using evidence-based method,and related studies of bowel preparation before colonoscopy in the past 5 years were searched.Database retrieved were as follows:Up To Date,BMJ Best Practice,National Institute for Health and Clinical Excellence(NICE),Australia based health care center syndrome(JBI)evidence summary database,Cochrane database,medical pulse flux,PubMed,CINAHL database and CNKI.The quality and grade of various studies were evaluated using the 2012 updated clinical guidelines research and evaluation system(AGREEⅡ)and the literature quality evaluation tool of JBI.Results Ten articles were enrolled,including 2 clinical decisions,4 guidelines,2 evidence summaries,and 2 systematic reviews.Totally 17 pieces of evidence for bowel preparation before colonoscopy in adults including health education,dietary guidance,timing of preparation,choice and use of laxatives,adjunctive drugs and bowel preparation for special patients were collected.Conclusion It is still necessary to combine the actual conditions of the medical institution,clinical experience of the medical staff and the needs of the patients to develop the best bowel preparation solutions.