结肠镜检查患者肠道准备的循证实践

Evidence-based practice of bowel preparation in colonoscopy patients

目的:总结提高结肠镜检查患者肠道准备质量的相关证据,将其应用于临床并进行效果评价。方法:计算机检索UpToDate、BMJ Best Practice、国际指南协作网、JBI循证卫生保健中心数据库、新西兰指南协作网、Cochrane Library、PubMed、中国生物医学文献数据库、中国知网、中华医学会期刊数据库、维普网等数据库中的有关提高结肠镜患者肠道准备质量的指南、专家共识、系统评价、证据总结等文献,首先进行证据汇总,然后进行基线审查,再将证据应用于临床,最后进行效果评价,评价实践人员结肠镜肠道准备相关得分、患者结肠镜一次性成功率及审查指标执行率。结果:证据应用后,33名医护人员肠道准备相关评分为(167.32±11.75)分,高于证据应用前的(140.23±19.07)分,差异有统计学意义(P<0.05)。证据应用后,55例患者结肠镜准备一次成功率为90.9%(50/55),高于证据应用前的63.6%(35/55),差异有统计学意义(P<0.05)。证据应用前,7条审查指标执行率为58.18%;证据应用后,7条审查指标的执行率为83.64%。结论:提高结肠镜患者肠道准备质量循证实践的实施,可提高实践人员肠道准备相关知识,提高患者结肠镜成功率。

Objective To summarize the relevant evidence for improving the quality of bowel preparation in patients undergoing colonoscopy,apply it to clinical practice,and evaluate its effectiveness.Methods Literature searches were conducted in databases including UpToDate,BMJ Best Practice,International Guidelines Network,JBI Evidence-based Healthcare Center,New Zealand Guidelines Group,Cochrane Library,PubMed,China National Knowledge Infrastructure(CNKI),Wanfang Data,Chinese Medical Association Journals Database,and VIP Database to retrieve guidelines,expert consensus,systematic reviews,evidence summaries,and other relevant documents on improving the quality of bowel preparation in colonoscopy patients.Firstly,evidence was summarized,followed by baseline review,clinical application of evidence,and finally effectiveness evaluation.The effectiveness evaluation included scores of healthcare practitioners'bowel preparation-related performance,the first-pass success rate of colonoscopy,and the compliance rate of review indicators.Results After applying the evidence,the bowel preparation-related scores of 33 healthcare practitioners were(167.32±11.75)points,higher than the pre-application scores of(140.23±19.07)points,with statistically significant differences(P<0.05).After applying the evidence,the first-pass success rate of colonoscopy preparation in 55 patients was 90.9%(50/55),higher than the pre-application rate of 63.6%(35/55),with statistically significant differences(P<0.05).Before applying the evidence,the compliance rate of the seven review indicators was 58.18%;after applying the evidence,the compliance rate of the seven review indicators was 83.64%.Conclusions Implementing evidence-based practice to improve the quality of bowel preparation in colonoscopy patients can enhance healthcare practitioners'knowledge related to bowel preparation and increase the success rate of colonoscopy in patients.