改良注水检查方案对结肠镜检查结肠息肉检出率、舒适度、炎症反应与肠道应激反应的影响

Effect of modified waterflood examination on the detection rate,comfort level,inflammatory response and intestinal stress response of colon polyps in colonoscopy.

目的探讨改良注水检查方案对结肠镜检查结肠息肉检出率、舒适度、炎症反应与肠道应激反应的影响。方法前瞻性纳入2022年2月至2023年4月于临汾市人民医院接受结肠镜检查的患者900例,根据随机数字表法分成改良注水组、注水组与注气组,各300例。比较3组达盲率、达盲时间、退镜时间、操作总时间、进镜长度,分别在检查中与检查后即刻,利用视觉模拟评分法(VAS)评估患者的检查舒适度。记录3组结直肠息肉检出率,并比较结肠镜检查相关并发症发生率。在检查前、检查后即刻,3组分别采血检测血清白细胞介素(IL)-1β、IL-6、肿瘤坏死因子-α(TNF-α)、血管紧张素-Ⅱ(AngⅡ)、皮质醇、去甲肾上腺素(NE)水平。结果改良注水组(98.00%)、注水组(96.67%)、注气组(96.00%)达盲率比较,差异无统计学意义(P>0.05)。改良注水组达盲时间、退镜时间、操作总时间短于注水组、注气组,差异均有统计学意义(P<0.05)。改良注水组检查中、检查后即刻的VAS评分低于注水组、注气组,差异均有统计学意义(P<0.05)。改良注水组、注水组息肉检出率分别为65.00%、60.33%,高于注气组(47.33%),差异均有统计学意义(P<0.05)。改良注水组、注水组结肠镜检查相关并发症率分别为6.67%、7.33%,低于注气组(17.33%),差异有统计学意义(P<0.05)。3组检查后即刻血清IL-1β、IL-6、TNF-α、AngⅡ、皮质醇、NE水平高于检查前,且改良注水组低于注水组、注气组,差异有统计学意义(P<0.05)。结论改良注水肠镜与常规注水肠镜检查能提高息肉检出率,其中改良注水肠镜能缩短结肠镜检查时间,提高患者受检舒适度,减轻炎症刺激与肠道应激反应。

Objective To compare the effects of modified waterflood examination on the detection rate,comfort level,inflammatory response and intestinal stress response of colon polyps in colonoscopy.Methods A total of 900 patients who received colonoscopy in Linfen People's Hospital from February 2022 to April 2023 were prospectively included,and were divided into the modified water injection group,water injection group and gas injection group according to random number table method,with 300 patients in each group.The blind rate,blind time,exit time,total operation time,and length of admission were compared among the three groups.Visual analog scale(VAS)was used to evaluate the comfort level of patients during and immediately after examination.Colorectal polyp detection rates were recorded in the three groups,and the incidence of colonoscopy-related complications was compared.The serum levels of interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),angiotensin-Ⅱ(AngⅡ),cortisol and norepinephrine(NE)were measured in the three groups before and immediately after examination.Results There was no difference in the access rate of improved water injection group(98.00%),water injection group(96.67%)and gas injection group(96.00%)(P>0.05).The blind time,mirror removal time and total operation time of the improved injection group were shorter than those of the injection group and gas injection group,the differences were statistically significant(P<0.05).VAS scores of modified waterflood group were lower than those of waterflood group and gas injection group during and immediately after inspection,the differences were statistically significant(P<0.05).The polyp detection rate in modified water injection group and water injection group 65.00%,60.33%,which was higher than that in gas injection group(47.33%),the difference was statistically significant(P<0.05).The rates of colonoscopy-related complications in the improved water injection group and in the water injection group was 6.67%and 7.33%respectively,which was lower than that in the gas injection group(17.33%),the difference was statistically significant(P<0.05).The serum levels of IL-1β,IL-6,TNF-α,AngⅡ,cortisol and NE in the three groups were higher immediately after examination,and those in the improved water injection group were lower than those in the water injection group and gas injection group,the differences were statistically significant(P<0.05).Conclusion The modified waterflood colonoscopy and conventional waterflood colonoscopy can improve the detection rate of polyps,and the modified waterflood colonoscopy can shorten the colonoscopy time,improve the comfort level of patients,and reduce inflammation and intestinal stress response.