不同年龄段结肠镜诊疗患者肠道准备质量差异分析及改进措施

Analysis of differences in the quality of bowel preparation in patients of different age groups undergoing colonoscopy and measures for improvement

目的通过分析结肠镜诊疗患者肠道准备质量差异的影响因素,探讨不同年龄段患者肠道准备的改进措施。方法选取2022年1月至2023年6月于我院行结肠镜诊疗的148例患者,依据渥太华肠道准备评价量表(Ottawa bowel preparation scale,OBPS)评分标准分为充分组(n=106)和不充分组(n=42),依据患者年龄划分为青年组(n=41)、中年组(n=91)和老年组(n=16),以高于中位年龄为高龄患者,低于中位年龄为低龄患者。收集患者临床资料,Logistic回归分析肠道准备质量的影响因素,多变量回归分析不同年龄分层患者肠道准备不充分的危险因素。结果148例患者肠道准备总合格率71.62%,中年组显著低于青年组(2=7.392,P=0.007)。高龄患者①段结肠OBPS评分(乙状结肠和直肠)、②段结肠OBPS评分(降结肠和横结肠)、③段结肠OBPS评分(盲肠和升结肠)均低于低龄患者(均P<0.05)。年龄、便秘、清肠剂剂量<75%、末次排便有固体残渣、镜检等待>6小时是肠道准备不充分的独立危险因素。在调整年龄后,末次排便有固体残渣和镜检等待>8小时是青年组患者肠道准备不充分的危险因素;便秘、清肠剂剂量<75%、末次排便有固体残渣和镜检等待时间中老年组患者肠道准备不充分的危险因素,镜检等待>8小时风险效应值高于镜检等待6~8小时(OR=3.657和OR=1.215,均P<0.05)。结论年龄是结肠镜诊疗患者肠道准备质量的风险因素,针对不同年龄段的患者,应采取不同的肠道准备策略。

Objective To explore improvements in bowel preparation for patients of different ages by analyzing the factors influencing differences in the quality of bowel preparation for patients undergoing colonoscopy.Methods One hundred and forty-eight patients who underwent colonoscopy in our hospital from January 2022 to June 2023 were selected and divided into adequate(n=106)and inadequate(n=42)groups based on the Ottawa bowel preparation scale scoring criteria,and into young(n=41),middle-aged(n=91),and elderly(n=16)groups based on the age of the patients,with higher than the median age being considered as the high age patients and lower than the median age as the low age patients.Clinical data were collected,logistic regression was used to analyze the factors affecting the quality of bowel preparation,and multivariate regression was used to analyze the risk factors for inadequate bowel preparation in patients of different age strata.Results The overall pass rate of bowel preparation in 148 patients was 71.62%.The middle-aged group was significantly lower than the young group(2=7.392,P=0.007).The①-segment colon OBPS scores(sigmoid colon and rectum),②-segment colon OBPS scores(descending colon and transverse colon),and③-segment colon OBPS scores(cecum and ascending colon)were lower in the senior patients than in the younger patients(all P<0.05).Age,constipation,bowel cleanser dose<75%,solid residue in the last bowel movement,and waiting>6 hours for microscopy were independent risk factors for inadequate bowel preparation.After adjusting for age,having solid residue in the last bowel movement,and waiting>8 hours for microscopy were risk factors for inadequate bowel preparation in the young group of patients.Constipation,bowel cleanser dose<75%,solid residue in the last bowel movement and waiting time for microscopy were risk factors for inadequate bowel preparation in patients in the middle-aged group.The risk effect value of waiting>8 hours for microscopy was higher than waiting 6 to 8 hours for microscopy(OR=3.657 and OR=1.215,all P<0.05).Conclusion Age is a risk factor for the quality of bowel preparation in patients undergoing colonoscopy,and different bowel preparation strategies should be used for different age groups.