Bristol粪便性状评估表在儿童结肠镜检查前肠道准备中的应用研究

Clinical value of Bristol stool form scale for bowel preparation in pediatric patients undergoing colonoscopy

摘要:

目的 评价Bristol粪便性状评估表（BSFS）用于儿童结肠镜检查前肠道准备的临床价值，并探讨其影响因素。 方法 采用方便抽样方法，以2016年5月至2016年12月收治于复旦大学附属儿科医院消化科拟行结肠镜检查的患儿为研究对象，经排除标准排除后共202例患儿纳入研究，统一使用聚乙二醇-4000分剂量服用联合饮食限制行肠道准备的方案。术前使用BSFS评估每次解便的性状，检查当日6∶00查看最近1次解便的性状，BSFS≤5分者加服聚乙二醇-4000（20 mL／kg），11∶00查看末次解便的性状，BSFS≤5分者取消当日结肠镜检查并延长肠道准备时间，BSFS 6分者予温生理盐水灌肠（灌肠组），BSFS 7分者不予温生理盐水灌肠（不灌肠组）。13∶00行结肠镜检查，术中使用Boston肠道准备评分表（BBPS）记录镜下视野清晰度，分为优、良、一般、差，其中优、良定义为肠道准备合格。灌肠组和不灌肠组肠道准备合格率比较使用卡方检验。按肠道准备是否合格分成2组（合格组和不合格组），根据数据类型，使用t（或t′）检验或卡方检验分析肠道准备质量的影响因素，单因素分析筛选出的因素再纳入多因素logistic回归分析，以寻求影响肠道准备质量的独立危险因素。检验水准为α=0.05。 结果 202例患儿在肠道准备期间平均排便次数为（14.4±6.8）次，不灌肠组165例（81.7％），灌肠组37例（18.3％），肠道准备合格患儿154例（76.2％），其中不灌肠组肠道准备合格率为75.2％（124／165），灌肠组肠道准备合格率为81.1％（30／37），2组肠道准备合格率比较差异无统计学意义（χ2=0.587，P=0.526）。单因素分析发现，合格组与不合格组在便秘史（χ2=32.588，P=0.000）、解便总次数（t=3.432，P=0.001）、BSFS 7分的次数（t′=2.877，P=0.005）方面差异有统计学意义。进一步多因素logistic回归分析显示，便秘史是肠道准备不合格的独立危险因素（P=0.000，OR=12.620，95％CI：4.850～32.800）。 结论 对于儿童结肠镜检查前的肠道准备，术前肉眼观察粪便性状并采用BSFS进行把控具有较好的临床应用价值，肠道准备合格率较高。但对于有便秘史的患儿，建议适当延长肠道准备时间以确保镜下视野清晰度。

Abstract:

Objective To evaluate the clinical value of Bristol stool form scale（BSFS） for bowel preparation in pediatric patients. Methods Data of 202 pediatric patients undergoing colonoscopy were collected from May 2016 to December 2016 at Children′s Hospital of Fudan University. All patients received polyethylene glycol （PEG）-4000 with clear fluid diet for bowel preparation. BSFS was used to record the stool form， and Boston bowel preparation scale （BBPS） was used to evaluate the quality of bowel cleansing. Differences in BBPS score between the enema group with BSFS 6 and the no enema group with BSFS 7 were studied. Based on the data types， t（or t′） test and chi-square test were used to analyze the influencing factors for colon preparation respectively. Those factors of statistical significance were studied with multivariate logistic regression analysis. Results The mean defecation time of pediatric patients during bowel preparation was 14.4±6.8. One hundred and sixty-five （81.7％） patients were assessed as 7 points in BSFS， 37 （18.3％） were 6 points in BSFS with supplemented enema， and 154（76.2％） patients achieved adequate bowel preparation. No significant differences were observed between the no enema group and enema group in the BBPS scores ［75.2%（124/165） VS 81.1%（30/37）， χ2=0.587, P=0.526］. Significant factors for inadequate colon preparation were constipation history（χ2=32.588，P=0.000）， total time of defecation（t=3.432，P=0.001） and total time of BSFS 7 （t′=2.877，P=0.005）. Multivariate logistic regression analysis showed constipation history（P=0.000，OR=12.620，95％CI：4.850-32.800） was independent risk factor for inadequate colon preparation. Conclusion Patients of BSFS 6 points could receive warm saline enema as a remedy. Patients with total time of defecation less than 15 and total time of BSFS （7 points） less than 8 are liable for the possibility of inadequate bowel preparation. It is also suggested that for patients with constipation history， the time of bowel preparation should be prolonged for microscopic visual field clarity.