本文選題：腸道準備 + 結腸鏡��； 參考：《山東大學》2017年碩士論文

【摘要】：背景和目的結腸鏡檢查是結直腸疾病診斷及結直腸腫瘤術后監(jiān)測的主要手段,其能夠在早期階段發(fā)現并切除結腸息肉或腺瘤,從而降低結直腸癌的發(fā)病風險。而結腸鏡檢查的成功取決于腸道準備的充分,失敗的腸道準備可降低結腸病變檢出率和盲腸插管成功率,并且增加進鏡難度及操作相關的并發(fā)癥發(fā)生率等。到目前為止,聚乙二醇(polyethyleneglycol,PEG)因其具有較高的安全性、較高的腸道準備充分率以及較好的患者耐受性,成為腸道準備中最常用藥物。在西方國家指南中PEG的常規(guī)用量為4 L,而在亞洲國家中常規(guī)用量為2 L,可能是因為亞洲人群與西方人群相比,有著較小的身材,更低的體重,不同的飲食習慣和較差的耐受性。一方面,結直腸手術已被證實是腸道準備不充分的一項危險因素。另一方面,臨床實踐證明結直腸切除術后患者在接受常規(guī)的2-L PEG方案進腸道準備時,其充分率是明顯不能滿足臨床要求的。所以此類患者需要使用一種強效的腸道準備用藥方案,以提高其腸道準備成功率。本實驗的目的是研究4-L PEG方案在亞洲人群結直腸術后患者腸道準備中的應用效果及患者對高劑量(4-L)PEG的耐受性、依從性,以探討4-L PEG方案是否可以作為此類患者的強化腸道準備方案。方法我們進行一項單中心、前瞻性、內鏡醫(yī)師單盲的實驗。結直腸術后患者隨機接受常規(guī)的2-L PEG早晨單次(morning-only 2-L,2-MO)或者是4-L PEG分次(split-dose 4-L,4-SD)腸道準備方案,結腸鏡檢查均安排在下午13:30至17:00進行。主要觀察指標為腸道準備的成功率。次級觀察指標包括息肉檢出率(polyp detection rate,PDR)、腺瘤檢出率(adenoma detection rate,ADR)、患者依從性、滿意度、耐受性,再次進行腸道準備的意愿以及進行腸道準備的困難程度。結果187名患者被隨機分到2-MO組(n=91)或4-SD組(n=94)。根據Aronchick量表評分,在意向性分析中(intention to treat,ITT),4-SD組腸道準備成功率高于2-MO組(89.4%vs.66.7%,P0.001),而在符合方案數據分析中(per protocol,PP),4-SD組腸道準備成功率仍均高于2-MO組(91.2%vs.68.9%,P0.001)。4-SD組患者對腸道準備過程的滿意度也優(yōu)于2-MO組。4-SD組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組。另外兩組患者在依從性、耐受性、再次進行腸道準備的意愿以及腸道準備的困難度方面沒有顯著性差異。結論4-SD方案在結直腸術后患者的腸道準備中優(yōu)于常規(guī)2-MO方案,因其有著較強的腸道準備效率及患者滿意度。盡管4-SD組患者睡眠質量較2-MO組受到更多干擾,兩組患者的依從性及耐受性是相當的。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.34

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