分次小容量聚乙二醇电解质溶液对于上午接受无痛结肠镜检查患者肠道清洁效果及耐受性的影响

Efficacy of bowel preparation and tolerability using split-dose low-volume polyethylene glycol for painless colonoscopy in the morning

摘要:

目的 对比不同容量的分剂量聚乙二醇电解质（PEG）溶液用于上午接受无痛结肠镜检查者的肠道清洁效果和耐受性。方法 选取2019年7月－2020年12月厦门弘爱医院上午接受无痛肠镜检查的患者520例，肠道清洁剂为PEG溶液，随机将患者分为3.0 L组（1.0 L+2.0 L）和2.0 L组（0.5 L+1.5 L）。主要观察终点为肠道准备充分程度，采用波士顿肠道准备评分（BBPS），评分 ≥ 6分且每一个肠段的评分 ≥ 2分为高质量的肠道准备。次要终点包括患者的依从性、不良反应以及腺瘤检出率。结果 最终纳入519例患者，3.0 L组259例，2.0 L组260例。两组患者在高质量肠道准备比率和总体BBPS之间无差异（P > 0.05）。2.0 L组更倾向于可以积极完成或愿意再次接受该方案进行肠道准备（P < 0.05）。在不良反应方面，2.0 L组腹胀更少（P = 0.000），睡眠缺失更少（P = 0.000）。两组患者腺瘤检出率比较，差异无统计学意义（P > 0.05）。末次服用肠道清洁剂的时间至结肠镜检查开始之间的等候时间与肠道黏膜的清洁度呈负相关（P < 0.05）。结论 将分剂量2.0 L容量的PEG溶液用于上午时段接受无痛结肠镜检查的患者，肠道准备效果满意，与分剂量3.0 L方案效果相似，但2.0 L方案可减轻肠道准备带来的腹部不适，耐受性更好，对患者睡眠影响少。

Abstract:

Objective To compare the efficacy of bowel preparation, patient compliance, and tolerability of different split-dose polyethylene glycol (PEG) electrolyte solution for painless colonoscopy in the morning.Method A single-blinded, randomized controlled trial was performed. 520 patients were randomized to (1.0 L + 2.0 L) 3.0 L-group and (0.5 L + 1.5 L) 2.0 L-group for bowel preparation from July 2019 to December 2020. Primary outcomes were adequate bowel preparation defined using the Boston bowel preparation scale (BBPS) ≥ 6 and each segmental score ≥2. Secondary outcomes included patient compliance, tolerability, effects on sleep, and adenoma detection rate.Results Among the 519 patients eligible for the study, 259 were in the 3.0 L-group and 260 were in the 2.0 L-group. No differences were observed for rates of high quality bowel preparation or overall BBPS (P > 0.05). Patients in 2.0 L-group were more likely to complete or repeat the entire preparation (P < 0.05). In terms of adverse events, patients in the 2.0 L-group reported less bloating (P = 0.000) and sleep deprivation (P = 0.000). There was no difference with regards to the adenoma detection rate (P > 0.05). The time interval between the last dose of bowel preparation and the start of colonoscopy was inversely correlated with the degree of mucosal cleanliness (P < 0.05).Conclusion Efficacy of bowel preparation using split-dose 2.0 L PEG electrolyte solution for painless colonoscopy in the morning that was not inferior to the split-dose 3.0 L PEG electrolyte solution. Preparation using a split-dose of 2.0 L PEG induced less abdominal discomfort and better tolerability.