本文關(guān)鍵詞：預(yù)包裝飲食與自備低渣食物對(duì)結(jié)腸鏡檢查腸道影響效果對(duì)比研究　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腸道準(zhǔn)備 結(jié)腸鏡檢查 預(yù)包裝飲食 低渣飲食 清潔度

【摘要】：目的:結(jié)腸鏡檢查目前已成為公認(rèn)的診斷和治療結(jié)腸疾病的金標(biāo)準(zhǔn),是篩查結(jié)腸癌的重要手段,結(jié)腸鏡檢查的成敗很大程度上取決于腸道準(zhǔn)備的質(zhì)量。理想的腸道準(zhǔn)備應(yīng)是能有效排空腸腔內(nèi)容物,保證醫(yī)生對(duì)鏡下腸道粘膜的細(xì)致觀察,且方便舒適,不引起嚴(yán)重不良反應(yīng)。目前國(guó)內(nèi)關(guān)于腸道準(zhǔn)備的研究主要集中在腸道清洗劑種類、劑量、用藥時(shí)機(jī)以及輔助用藥等,關(guān)于飲食對(duì)腸道準(zhǔn)備質(zhì)量影響的研究特別少,為此,本研究通過(guò)對(duì)比預(yù)包裝飲食與自備低渣食物對(duì)腸道準(zhǔn)備質(zhì)量的影響,探討兩組在腸道清潔度、排便變化、副反應(yīng)、息肉檢出率、患者滿意度及醫(yī)務(wù)人員滿意度、糖尿病人空腹血糖變化等方面的不同,評(píng)估此方案的有效性、安全性、耐受性,為臨床腸道準(zhǔn)備提供理論依據(jù)。方法:本研究納入155例于2016年1月-2016年6月在武警總醫(yī)院院行結(jié)腸鏡檢查的門(mén)診患者作為研究對(duì)象,隨機(jī)分為預(yù)包裝飲食組和自備低渣飲食組,采用單中心、單盲、前瞻性、對(duì)照研究。預(yù)包裝飲食組(預(yù)包裝組)檢查前一天三餐攝入預(yù)包裝食物,自備低渣飲食組(自備組)檢查前一天按照常規(guī)攝入自備低渣飲食,兩組清腸液均采用復(fù)方聚乙二醇電解質(zhì)散3L,于檢查當(dāng)日晨4點(diǎn)口服。通過(guò)渥太華評(píng)分標(biāo)準(zhǔn)(Ottawa bowel preparation scale,OBPS)評(píng)價(jià)兩組患者腸道清潔程度;通過(guò)調(diào)查問(wèn)卷收集患者進(jìn)食及服藥期間副反應(yīng)、飲食依從性、對(duì)預(yù)包裝飲食滿意度及對(duì)復(fù)方聚乙二醇電解質(zhì)散(Sulfate-free Polyethylene Glycol Electrolyte Powder,SF-PEG)滿意度,通過(guò)采集靜脈血監(jiān)測(cè)糖尿病患者空腹血糖變化以檢測(cè)預(yù)包裝飲食配方對(duì)糖尿病人適用性。采用SPSS 17.0軟件進(jìn)行統(tǒng)計(jì)分析,兩組計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差((?)±S)表示,組間比較采用獨(dú)立樣本u或t’檢驗(yàn),非正態(tài)分布的計(jì)量資料和計(jì)數(shù)資料行x2檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:5例患者因未完成大腸鏡檢查而被剔除出實(shí)驗(yàn),最終150例患者(預(yù)包裝組75例,自備組75例)進(jìn)入最后分析,腸鏡均到達(dá)回盲部,兩組患者的基本資料(性別、年齡、體重指數(shù)、便秘史、腸鏡史、糖尿病史)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義。1主要評(píng)估指標(biāo)1)腸道清潔度:預(yù)包裝組渥太華評(píng)分總分(3.13±1.41)分,低于自備低渣飲食組(5.11±0.91)分,預(yù)包裝組腸道清潔度高,差異有統(tǒng)計(jì)學(xué)意義(p0.05);其中,預(yù)包裝組左側(cè)結(jié)腸(0.75±0.55)分,自備組左側(cè)結(jié)腸(1.24±0.45)(p0.05),兩組比較有統(tǒng)計(jì)學(xué)意義;預(yù)包裝組右側(cè)結(jié)腸(0.45±0.31),清潔度優(yōu)于自備組(1.85±0.59)(p0.05),兩組比較有有統(tǒng)計(jì)學(xué)意義;預(yù)包裝組橫結(jié)腸(1.11±0.52),自備組橫結(jié)腸(0.78±0.44)(p0.05)兩組比較無(wú)統(tǒng)計(jì)學(xué)意義;液體量預(yù)包裝組(0.82±0.69),自備組(1.24±0.67),兩組比較無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。預(yù)包裝組腸道準(zhǔn)備合格率88.0%,自備組腸道準(zhǔn)備合格率69.3%,兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05)。2)排便情況:包括首次排便時(shí)間,排便次數(shù),預(yù)包裝組第一次排便時(shí)間(46.25±28.23)分,明顯少于自備組(65.34±34.54)分,兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05),預(yù)包裝組排便次數(shù)(5.67±1.63)次,少于自備組(8.24±2.26),兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05),預(yù)包裝組進(jìn)鏡時(shí)間(5.35±1.63)分,少于自備組(8.24±2.26)分,兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05)。3)息肉發(fā)現(xiàn)率:預(yù)包裝組息肉發(fā)現(xiàn)率37.3%,自備組息肉發(fā)現(xiàn)率32.0%,兩組比較無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。2次要評(píng)估指標(biāo)1)飲食依從性及副反應(yīng):預(yù)包裝組患者飲食依從性94.7%,自備組只有69.3%,兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05),預(yù)包裝組患者86.7%愿意重復(fù)此次飲食方案,自備組60.0%愿意重復(fù)此次飲食方案,兩組差異有統(tǒng)計(jì)學(xué)意義(p0.05);副作用方面,預(yù)包裝組惡心15例,嘔吐9例,腹痛6例,腹脹3例,頭暈4例,乏力5例,自備組惡心18例,嘔吐10例,腹痛8例,腹脹2例,頭暈6例,乏力8例,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。2)醫(yī)務(wù)人員滿意度:調(diào)查所有內(nèi)鏡醫(yī)師、門(mén)診醫(yī)師和護(hù)士對(duì)預(yù)包裝組飲食滿意度均為100%,對(duì)自備組飲食滿意度分別為45.5%(p0.05)、56.0%(P0.05)、33.6%(P0.05)。3)觀察糖尿病患者結(jié)腸鏡檢查前血糖值變化,與平時(shí)空腹血糖對(duì)比,未出現(xiàn)明顯波動(dòng),無(wú)低血糖反應(yīng)。結(jié)論:1預(yù)包裝飲食用于結(jié)腸鏡檢查飲食準(zhǔn)備安全有效,腸道清潔度優(yōu)于自備低渣飲食組。2預(yù)包裝飲食用于結(jié)腸鏡檢查飲食準(zhǔn)備可以縮短第一次排便時(shí)間、減少排便次數(shù),縮短進(jìn)鏡時(shí)間,提高腸鏡檢查質(zhì)量。3預(yù)包裝飲食可以提高病人飲食準(zhǔn)備依從性,同時(shí)提高病人和醫(yī)務(wù)人員滿意度。
[Abstract]:Objective: colonoscopy has become the gold standard for the diagnosis and treatment of colon disease recognized, is an important means of screening for colon cancer, the quality of the success of colonoscopy depends largely on bowel preparation. Ideal bowel preparation should be effective emptying of luminal contents, ensure doctors to carefully observe intestinal endoscopic the mucous membrane, and convenient and comfortable, does not cause serious adverse reactions. At present, the domestic research on intestinal preparation mainly concentrated in the intestinal cleaning agent types, dosage, medication time and auxiliary medicine, research on diet preparation quality effect on intestinal are very few, therefore, this study by comparing the pre packaged food and food - low residue influence on the quality of bowel preparation, to investigate the two groups in the intestinal cleanliness, defecation changes, adverse reactions, the detection rate of polyps, patients satisfaction and satisfaction of medical staff, patients with diabetes fasting blood glucose change Other aspects of the different, to assess the effectiveness of this scheme, the safety, tolerability, and provide a theoretical basis for clinical intestinal preparation. Methods: This study included 155 patients in January 2016 -2016 year in June in the armed police general hospital for outpatient colonoscopy patients as the research object, randomly divided into pre packaged diet group and self low residue diet group, single center, single blind, prospective, controlled study. Pre packaged diet group (pre packaging group) a day before meals intake check pre packaged food, low residue diet group (self owned group) the day before the inspection in accordance with the conventional intake - low residue diet, two groups were using Qingchang liquid polyethylene glycol electrolyte powder 3L, to check the same day at 4 a.m. by oral administration. Ottawa (Ottawa bowel preparation scale standard for evaluation, OBPS) evaluation of two groups of patients with intestinal cleanliness; through the questionnaire were collected and eating during medication side effects, drink Food compliance, satisfaction and diet on pre packaged of polyethylene glycol electrolyte powder (Sulfate-free Polyethylene Glycol Electrolyte Powder, SF-PEG) satisfaction, through changes in venous blood fasting blood sugar monitoring to detect pre packaged diet formula for diabetes applicability. Statistical analysis was performed using SPSS 17 software, two sets of measurement data to mean + the standard deviation ((?) + S) said that the groups were compared using independent samples u or T 'test, measurement data and count data for testing of the normal distribution of X2, P0.05 were statistically significant. Results: 5 patients did not complete due to the colonoscopy were excluded from the experiment, the final 150 cases patients (pre packaged group 75 cases, group owned 75 cases) in the final analysis, colonoscopy arrives at the ileocecal valve, the basic data of the two groups (gender, age, BMI, history of constipation, colonoscopy history, diabetes history comparison), 宸紓鏃犵粺璁″鎰忎箟.1涓昏璇勪及鎸囨爣1)鑲犻亾娓呮磥搴，

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