复方聚乙二醇电解质散末次服药时间对结肠镜检查质量的影响

Effect of last dose time of polyethylene glycol electrolyte on the quality of colonoscopy

摘要:

目的 探讨复方聚乙二醇电解质散末次服药时间对结肠镜检查质量的影响。方法 选取2020年3月－2020年9月于重庆医科大学附属永川医院内镜中心行结肠镜检查的1 612例门诊患者作为研究对象，采用随机数表法将1 612例患者分为干预A组（n = 403）、干预B组（n = 403）、对照A组（n = 403）和对照B组（n = 403）。其中，干预A组有3例药物剂量服用错误，干预B组有5例数据部分缺失，对照A组有2例肠道清洁剂种类错误，对照B组有6例数据缺失，以上16例数据被剔除。该研究最终共纳入1 596例，干预A组400例，干预B组398例，对照A组401例，对照B组397例。干预组：末次服药时间按照预约次序依次延长15 min，末次服药时间至镜检开始时间间隔（以下简称时间间隔）控制在3～5 h。其中，干预A组镜检时间为8点至10点和14点至16点，干预B组镜检时间为10点至12点和16点至18点。对照组：末次服药时间固定，上午检查者末次服药时间为5点，下午检查者末次服药时间为11点。其中，对照A组镜检时间为8点至10点和14点至16点，时间间隔维持在3～5 h，对照B组镜检时间为10点至12点和16点至18点，时间间隔 > 5 h。根据波士顿肠道准备量表（BBPS）评分，记录每位受检者肠道准备情况，并详细记录进退镜时间和息肉检出情况。结果 各组时间间隔分别为：干预A组3.88（3.31，4.45）h，干预B组4.01（3.26，4.51）h，对照A组4.30（3.95，4.65）h，对照B组5.91（5.70，6.25）h。对照B组的BBPS评分和息肉检出率明显低于干预A组、干预B组及对照A组，进退镜时间也较其他3组明显延长，差异均有统计学意义（P < 0.05）；对照A组、干预A组及干预B组之间的BBPS评分、息肉检出率和进退镜时间行两两比较，差异均无统计学意义（P > 0.05）。结论 末次服药时间控制在镜检开始前3～5 h，可获得较好的肠道准备质量。通过调整末次服药时间，可提高预约次序较后患者的肠道准备质量和息肉检出率，并缩短进退镜时间。

Abstract:

Objective To investigate the effect of the last dose time of polyethylene glycol electrolyte on colonoscopy quality.Methods 1 612 outpatients who underwent colonoscopy from March 2020 to September 2020 were selected as the research objects. 1 612 patients were divided into 4 groups by random number table method: intervention A group (n = 403), intervention group B (n = 403), control group A (n = 403) and control group B (n = 403). Among them, 3 cases in the intervention group A had wrong drug dosage, 5 cases in the intervention group B had partial missing data, 2 cases in the control group A had the wrong type of bowel cleaner, and 6 cases in the control group B had missing data, so the above 16 cases were excluded from the study. A total of 1 596 cases were finally included in this study, with intervention group A (n = 400), intervention group B (n = 398), control group A (n = 401), and control group B (n = 397). Intervention group: The last dose time was extended by 15 min in the order of appointment, and the time interval from the last dose time to the start of colonoscopy (hereinafter referred to as the time interval) was controlled within 3 ~ 5 h. The colonoscopy time of intervention group A was 8 to 10 o'clock and 14 to 16 o'clock, and the colonoscopy time of intervention group B was 10 to 12 o'clock and 16 to 18 o'clock. Control group: The last dose time was fixed, the last dose time of patients undergoing colonoscopy in the morning was 5:00, and the last dose time of patients undergoing colonoscopy in the afternoon was 11:00. The colonoscopy time of control group A was 8 to 10 o'clock and 14 to 16 o'clock, and the time interval was maintained between 3 ~ 5 h; the colonoscopy time of control group B was 10 to 12 o'clock and 16 to 18 o'clock, and the time interval was greater than 5 hours. According to the Boston bowel preparation scale (BBPS) score, the bowel preparation score of each subject was recorded, and the insertion time and withdrawal time and polyp detection were recorded in detail.Results The time intervals of each group were: intervention group A 3.88 (3.31, 4.45) h, intervention group B 4.01 (3.26, 4.51) h, control group A 4.30 (3.95, 4.65) h, control group B 5.91 (5.70, 6.25) h. The BBPS score and polyp detection rate of the control group B were significantly lower than those of the intervention group A, the intervention group B and the control group A, and insertion and withdrawal time of colonoscopy was also significantly longer than the other three groups, and the differences were statistically significant (P < 0.05). There was no significant difference in BBPS score, polyp detection rate, and colonoscopy advancing and retreating time among control group A, intervention group A, and intervention group B (P > 0.05).Conclusion Better bowel preparation quality can be obtained when the last dose is 3 ~ 5 h before colonoscopy. By adjusting the last dose time, the bowel preparation quality and polyp detection rate of patients with later appointments can be improved, and the colonoscopy insert and withdraw time can be shortened.