当前位置:主页 > 医学论文 > 肿瘤论文 >

结直肠切除术后患者结肠镜前肠道准备强化用药方案的前瞻性研究

发布时间:2018-05-29 00:13

  本文选题:肠道准备 + 结肠镜 ; 参考:《山东大学》2017年硕士论文


【摘要】:背景和目的结肠镜检查是结直肠疾病诊断及结直肠肿瘤术后监测的主要手段,其能够在早期阶段发现并切除结肠息肉或腺瘤,从而降低结直肠癌的发病风险。而结肠镜检查的成功取决于肠道准备的充分,失败的肠道准备可降低结肠病变检出率和盲肠插管成功率,并且增加进镜难度及操作相关的并发症发生率等。到目前为止,聚乙二醇(polyethyleneglycol,PEG)因其具有较高的安全性、较高的肠道准备充分率以及较好的患者耐受性,成为肠道准备中最常用药物。在西方国家指南中PEG的常规用量为4 L,而在亚洲国家中常规用量为2 L,可能是因为亚洲人群与西方人群相比,有着较小的身材,更低的体重,不同的饮食习惯和较差的耐受性。一方面,结直肠手术已被证实是肠道准备不充分的一项危险因素。另一方面,临床实践证明结直肠切除术后患者在接受常规的2-L PEG方案进肠道准备时,其充分率是明显不能满足临床要求的。所以此类患者需要使用一种强效的肠道准备用药方案,以提高其肠道准备成功率。本实验的目的是研究4-L PEG方案在亚洲人群结直肠术后患者肠道准备中的应用效果及患者对高剂量(4-L)PEG的耐受性、依从性,以探讨4-L PEG方案是否可以作为此类患者的强化肠道准备方案。方法我们进行一项单中心、前瞻性、内镜医师单盲的实验。结直肠术后患者随机接受常规的2-L PEG早晨单次(morning-only 2-L,2-MO)或者是4-L PEG分次(split-dose 4-L,4-SD)肠道准备方案,结肠镜检查均安排在下午13:30至17:00进行。主要观察指标为肠道准备的成功率。次级观察指标包括息肉检出率(polyp detection rate,PDR)、腺瘤检出率(adenoma detection rate,ADR)、患者依从性、满意度、耐受性,再次进行肠道准备的意愿以及进行肠道准备的困难程度。结果187名患者被随机分到2-MO组(n=91)或4-SD组(n=94)。根据Aronchick量表评分,在意向性分析中(intention to treat,ITT),4-SD组肠道准备成功率高于2-MO组(89.4%vs.66.7%,P0.001),而在符合方案数据分析中(per protocol,PP),4-SD组肠道准备成功率仍均高于2-MO组(91.2%vs.68.9%,P0.001)。4-SD组患者对肠道准备过程的满意度也优于2-MO组。4-SD组PDR(59.6%vs.49.5%,P=0.125)及 ADR(22.3%vs.12.9%,P=0.091)均略高于2-MO组。另外两组患者在依从性、耐受性、再次进行肠道准备的意愿以及肠道准备的困难度方面没有显著性差异。结论4-SD方案在结直肠术后患者的肠道准备中优于常规2-MO方案,因其有着较强的肠道准备效率及患者满意度。尽管4-SD组患者睡眠质量较2-MO组受到更多干扰,两组患者的依从性及耐受性是相当的。
[Abstract]:Background and objective colonoscopy is the main method for the diagnosis of colorectal diseases and postoperative monitoring of colorectal neoplasms. It can detect and remove colorectal polyps or adenomas at the early stage, thus reducing the risk of colorectal cancer. The success of colonoscopy depends on the sufficient preparation of the intestine. The failure of intestinal preparation can reduce the detection rate of colonic lesions and the success rate of caecal intubation, and increase the difficulty of colonoscopy and the incidence of complications related to the operation. So far, polyethylene glycol polyethyleneglycoll (PEG) has become the most commonly used drug in intestinal preparation because of its high safety, high bowel preparation adequacy rate and better patient tolerance. The conventional dose of PEG in the Western guidelines is 4 L, while in the Asian countries it is 2 L, probably because the Asian population has a smaller body size, lower body weight, different eating habits and poor tolerance than the Western population. On the one hand, colorectal surgery has been shown to be a risk factor for inadequate bowel preparation. On the other hand, clinical practice has proved that the adequacy rate of the patients after colorectal resection can not meet the clinical requirements obviously when they receive the routine 2-L PEG regimen for bowel preparation. Therefore, these patients need to use a strong bowel preparation regimen to improve the success rate of bowel preparation. The purpose of this study was to study the effects of 4-L PEG regimen on intestinal preparation of patients after colorectal surgery in Asia, and to study the tolerance and compliance of patients with high dose of 4-L PEG. To explore whether the 4-L PEG regimen can be used as an enhanced bowel preparation protocol in these patients. Methods We conducted a single-center prospective single-blind endoscopic trial. Patients after colorectal surgery were randomly assigned to receive routine 2-L PEG morning-only 2-L2-MOs or 4-L PEG split-dose 4-L4-SD) bowel preparation protocols. Colonoscopy was performed from 13:30 to 17:00. The main outcome measure was the success rate of intestinal preparation. The secondary indicators included polyp detection ratetid, adenoma detection ratetadr, patient compliance, satisfaction, tolerance, willingness to prepare again and difficulty in intestinal preparation. Results 187 patients were randomly divided into 2-MO group (n = 91) or 4-SD group (n = 94). According to the Aronchick scale, In the intentionality analysis, the success rate of intestinal preparation in the intention-to-treat-ITT 4-SD group was higher than that in the 2-MO group (89.4vs.66.7 / P0.001), while the success rate of intestinal preparation in the 2-MO 4-SD group was still higher than that in the 2-MO group (91.2vs.68.9P0.001n.4-SD). It was also better than that in the 2-MO group. The values of vs.49.5and ADR 22.3vs.12.9P0.091 in group D were slightly higher than those in group 2-MO. There were no significant differences between the other two groups in terms of compliance, tolerance, willingness to prepare again and difficulty of bowel preparation. Conclusion 4-SD regimen is superior to conventional 2-MO regimen in intestinal preparation after colorectal surgery because of its strong intestinal preparation efficiency and patient satisfaction. Although sleep quality was more disturbed in 4-SD group than in 2-MO group, compliance and tolerance were comparable between the two groups.
【学位授予单位】:山东大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R735.34

【参考文献】

相关期刊论文 前4条

1 Hardik Shah;Devendra Desai;Hrishikesh Samant;Sandeep Davavala;Anand Joshi;Tarun Gupta;Philip Abraham;;Comparison of split-dosing vs non-split(morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy[J];World Journal of Gastrointestinal Endoscopy;2014年12期

2 Jonathan D Godfrey;Robert E Clark;Abhishek Choudhary;Imran Ashraf;Michelle L Matteson;Srinivas R Puli;Matthew L Bechtold;;Ascorbic acid and low-volume polyethylene glycol for bowel preparation prior to colonoscopy:A meta-analysis[J];World Journal of Meta-Analysis;2013年01期

3 冯仙菊;赵秋月;马薇薇;颜兴芬;;复方聚乙二醇电解质散联合乳果糖口服液在老年患者结肠镜检查前肠道准备的应用[J];现代中西医结合杂志;2013年03期

4 张瑜;李利;;糖尿病患者血糖控制程度对肠镜检查肠道清洁度的影响[J];中华护理杂志;2010年12期



本文编号:1948741

资料下载
论文发表

本文链接:https://www.wllwen.com/yixuelunwen/zlx/1948741.html


Copyright(c)文论论文网All Rights Reserved | 网站地图 |

版权申明:资料由用户5306a***提供,本站仅收录摘要或目录,作者需要删除请E-mail邮箱bigeng88@qq.com