基于不同肠段的结肠镜检查人群肠道准备失败现状及影响因素分析

Influencing factors for inadequate bowel preparation of colonoscopy of different colonic segments

摘要:

目的 研究不同肠段发生肠道准备失败的现状，并分析其影响因素。方法 选取2021年12月—2023年1月在北京协和医院消化内镜中心进行结肠镜检查的677例患者作为研究对象，患者均采用3 L聚乙二醇电解质散分次剂量的标准化肠道准备方案，以波士顿肠道准备评分量表对患者的肠道准备情况进行评估，并通过Logistic回归模型分析不同肠段发生肠道准备失败的影响因素。结果 结肠镜检查人群的肠道准备不合格率为31.5%（213/677），在肠道准备失败人群中，仅近端肠道失败占85.4%（182/213），全肠道失败占14.1%（30/213），仅远端肠道失败仅占0.5%（1/213）。将仅远端肠道失败与全肠道失败合并为发生远端肠道准备失败，Logistic回归分析结果显示：男性（P=0.001，OR=2.253，95%CI：1.399~3.629）、门诊患者（P<0.001，OR=4.175，95%CI：2.410~7.231）、无结直肠癌家族史（P=0.001，OR=2.117，95%CI：1.365~3.284）以及因诊断行结肠镜检查（P=0.003，OR=1.978，95%CI：1.261~3.102）的人群更容易发生近端肠道准备失败；有脊柱病史（P=0.044，OR=7.430，95%CI：1.051~52.511）、门诊患者（P<0.001，OR=135.577，95%CI：29.135~630.883）、不能按照饮食要求进食（P=0.006，OR=4.772，95%CI：1.576~14.453）、肠道准备期间出现不良反应（P=0.015，OR=4.341，95%CI：1.329~14.179）、无结直肠癌家族史（P=0.003，OR=7.110，95%CI：1.912~26.438）、末次大便性状较差（P=0.001，OR=25.922，95%CI：3.779~177.832）的人群更容易发生远端肠道准备失败。结论 结肠镜检查人群肠道准备失败主要发生在近端肠道，且影响近、远端肠道发生肠道准备失败的因素存在较大差异，未来需要根据不同肠段的特点开展特异性的干预措施，以提高肠道准备质量。

Abstract:

Objective To investigate the influencing factors for inadequate bowel preparation of colonoscopy. Methods A total of 677 patients who underwent colonoscopy at Peking Union Medical College Hospital from December 2021 to January 2023 were recruited, and all patients underwent standardized bowel preparation by using 3 L polyglycol electrolyte powder with fractional dose. The quality of bowel preparation was assessed by Boston bowel preparation scale, and the influencing factors for inadequate bowel preparation were analyzed by logistic regression analysis. Results The rate of inadequate bowel preparation was 31.5% (213/677). Among the patients with inadequate bowel preparation, 85.4% (182/213) inadequate bowel preparation was only in proximal colon, 14.1% (30/213) was in both proximal and distal colon, and 0.5% (1/213) was only in distal colon. Inadequate bowel preparation in distal colon and total colon were combined into inadequate bowel preparation in distal colon. The results of logistic regression analysis showed that inadequate bowel preparation in proximal colon was more likely to occur in men (P=0.001, OR=2.253, 95%CI: 1.399-3.629), outpatients (P<0.001, OR=4.175, 95%CI: 2.410-7.231), those with no family history of colorectal cancer (P=0.001, OR=2.117, 95%CI: 1.365-3.284), and diagnostic colonoscopy (P=0.003, OR=1.978, 95%CI: 1.261-3.102). And spinal disease (P=0.044, OR=7.430, 95%CI: 1.051-52.511), outpatients (P<0.001, OR=135.577, 95%CI: 29.135-630.883),non-compliance of dietary requirements (P=0.006, OR=4.772, 95%CI: 1.576-14.453), adverse reaction during bowel preparation (P=0.015, OR=4.341, 95%CI: 1.329-14.179), no family history of colorectal cancer (P=0.003, OR=7.110, 95%CI: 1.912-26.438), and poor last stool character (P=0.001, OR=25.922, 95%CI: 3.779-177.832) were risk factors for inadequate bowel preparation in distal colon. Conclusions The inadequate bowel preparation of colonoscopy mainly occurs in proximal colon, and the risk factors for the inadequate bowel preparation vary in different colonic segments. Therefore, the specific interventions should be performed according to the character of different colon segments to improve the quality of bowel preparation.