利那洛肽联合西甲硅油与复方聚乙二醇电解质散对便秘患者肠道清洁效果的影响

Effect of Linaclotide combined with Simethicone and compound polyethylene glycol electrolyte on cleansing effect of bowel in patients with constipation

摘要:

目的 探讨利那洛肽联合西甲硅油与复方聚乙二醇电解质散（PEG）对便秘患者肠道清洁效果的有效性和安全性。方法 采用前瞻性随机对照试验，通过单盲法，纳入2023年4月－2024年8月于该院消化内镜中心行结肠镜检查的便秘患者383例，随机分为常规组（128例）、实验A组（128例）和实验B组（127例）。常规组采用3 L PEG（Ⅰ）溶液，实验A组采用290 μg利那洛肽 + 2 L PEG溶液，实验B组采用290 μg利那洛肽 + 30 mL西甲硅油+2 L PEG溶液。比较3组患者的肠道准备效果［Boston肠道准备量表（BBPS）评分和去泡效果］、病变检出率、首次排便间隔时间、排便次数、盲肠插管成功率、进镜时间、退镜时间、不良反应发生率和重复检查意愿等。结果 3组患者BBPS评分比较，差异无统计学意义（P > 0.05）；实验B组的去泡效果评分明显低于常规组和实验A组，差异均有统计学意义（P < 0.05）；实验B组的病变总检出率和息肉检出率明显高于常规组和实验A组，差异均有统计学意义（P < 0.05）；常规组的首次排便间隔时间明显长于实验A组和实验B组，差异均有统计学意义（P < 0.05）；3组患者排便次数比较，差异无统计学意义（P > 0.05）；3组患者盲肠插管成功率均为100.0%，进镜时间相当，差异均无统计学意义（P > 0.05）；实验B组的退镜时间明显短于常规组和实验A组，差异均有统计学意义（P < 0.05）；常规组腹胀腹痛发生率和不良反应总发生率明显高于实验A组和实验B组，差异均有统计学意义（P < 0.05）；常规组重复检查意愿率明显低于实验A组和实验B组，差异均有统计学意义（P < 0.05）。结论 290 μg利那洛肽联合30 mL西甲硅油与2 L PEG溶液方案在便秘患者肠道准备上具有优势，较3 L PEG溶液和290 μg利那洛肽+2 L PEG溶液方案，可获得更好的肠道清洁效果，且安全性和患者重复检查意愿率高，可作为便秘患者肠道准备的推荐方案。

Abstract:

Objective To investigate the efficacy and safety of Linaclotide combined with Simethicone oil and compound polyethylene glycol electrolyte (PEG) for cleansing effect of bowel in patients with constipation.Methods A prospective randomized controlled trial was designed and implemented by single blind method. 383 patients with constipation who underwent colonoscopy from April 2023 to August 2024 were enrolled and randomly divided into routine group (128 cases), experimental group A (128 cases) and experimental group B (127 cases). Routine group treated with 3 L PEG, experimental group A treated with 290 μg Linaclotide + 2 L PEG and experimental group B treated with 290 μg Linaclotide + 30 mL Simethicone + 2 L PEG. Bowel preparation effect [Boston bowel preparation scale (BBPS) scores and foaming removal effect], lesion detection rate, first defecation interval, frequency of defecation, the success rate of cecal intubation, the insertion time of colonoscopy, the withdrawal time of colonoscopy, incidence of adverse reactions and willingness to repeat examination of the three groups were compared.Results No statistically significant differences were observed in the BBPS scores among the three groups (P > 0.05); The foaming removal effect score in experimental group B was significantly lower than that in routine group and experimental group A, the difference was statistically significant (P < 0.05); The total lesion detection rate and polyps detection rate of experimental group B were significantly higher than those of routine group and experimental group A, the differences were statistically significant (P < 0.05). The first defecation interval of the routine group was significantly longer than that of experimental group A and experimental group B, the difference was statistically significant (P < 0.05); The frequency of defecation was compared among the three groups, and the difference was no statistically significant (P > 0.05). The success rate of cecal intubation in the three groups was 100.0%, and the insertion time of colonoscopy was similar, the differences were not statistically significant (P > 0.05); The withdrawal time of colonoscopy in experimental group B was significantly shorter than that in routine group and experimental group A, the difference was statistically significant (P < 0.05). The incidence of abdominal distension and total adverse reactions in the routine group were higher than those in experimental group A and experimental group B, the differences were statistically significant (P < 0.05); The willingness to repeat examination rate of the routine group was significantly lower than that of experimental group A and experimental group B, the differences were statistically significant (P < 0.05).Conclusion 290 μg Linaclotide combined with 30 mL Simethicone and 2 L PEG solution regimen has advantages in intestinal preparation for patients with constipation, and can achieve better intestinal cleaning effect than 3 L PEG solution and 290 μg linalopeptide+2 L PEG solution regimen, with higher safety and willingness to repeat examination. It can be recommended for bowel preparation for patients with constipation.