基于新型团体标准改善门诊患者结肠镜检查肠道准备合格率的应用研究

    Application of a novel group standard to improve the adequacy rate of bowel preparation for colonoscopy in outpatients

    • 摘要:
      目的 探讨基于《TSHNA 0003-2023消化内镜诊疗前消化道准备》团体标准提升门诊结肠镜检查病人肠道准备合格率的效果。
      方法 选取2024年6—9月在上海市复旦大学附属闵行医院内镜中心行结肠镜诊疗的病人,将应用标准前后的病人分别作为对照组和干预组,通过随机抽样法进一步分析。对照组按照常规结肠镜检查肠道准备,检查前告知病人肠道清洁剂服用方法,发放注意事项书面材料; 干预组根据团体标准进行个体化干预,包括基础情况评估、饮食指导、用药指导、不良反应的预防及处理措施等。根据波士顿肠道准备评分量表(Boston评分)评估肠道准备情况(≥6分为合格)。通过线性回归模型评估干预组Boston评分的改善程度。比较病人不良反应发生以及就诊体验满意度情况。
      结果 总计1 198例门诊结肠镜检查病人纳入分析,其中对照组598例,干预组600例。干预组病人肠道准备合格率明显高于对照组(88.33% vs 82.61%,P < 0.01)。校正混杂因素后,干预组比对照组Boston评分提高1.78分(P < 0.01)。干预策略主要改善了使用磷酸钠盐散、硫酸镁钠钾和硫酸镁作为肠道清洁剂的病人的Boston评分,且不良反应发生率明显低于对照组(P < 0.01)。同时,干预策略显著提高了结肠病变的检出率和病人就诊体验满意度(P < 0.05和P < 0.01)。
      结论 基于《TSHNA 0003-2023》团体标准下的个体化肠道准备干预策略能有效提升门诊病人结肠镜检查肠道准备合格率,降低不良反应发生率,提高病变检出率,提升病人就诊体验满意度,应用效果显著,值得临床广泛应用和推广。

       

      Abstract:
      Objective To explore the effect of the group standard "TSHNA 0003-2023 Digestive Endoscopy Preoperative Gastrointestinal Preparation" on improving the adequacy rate of bowel preparation for colonoscopy in outpatients.
      Methods Patients who underwent colonoscopy diagnosis and treatment at the Endoscopy Center of Minhang Hospital Affiliated to Fudan University in Shanghai from June to September 2024 were selected.Those who underwent standard procedures before and after the intervention were assigned to the control group and the intervention group, respectively, with further analysis conducted using random sampling.The control group followed the conventional colonoscopy bowel preparation protocol, patients were informed about the method of taking bowel preparation before the examination and provided with written instructions.The intervention group received personalized interventions based on the group standard, including baseline assessment, dietary guidance, medication guidance, and measures for preventing and managing adverse reactions.Bowel preparation was assessed using the Boston bowel preparation scale (BBPS) (score ≥6 points was considered adequate).The improvement in BBPS scores in the intervention group was evaluated using a linear regression model.The occurrence of edverse reactions and patients′ satisfaction were compared.
      Results A total of 1 198 outpatients undergoing colonoscopy were included in the analysis, comprising 598 in the control group and 600 in the intervention group.The bowel preparation adequacy rate was significantly higher in the intervention group compared to the control group (88.33% vs 82.61%, P < 0.01).After adjusting for confounding factors, the intervention group demonstrated a 1.78-point improvement in Boston scores over the control group (P < 0.01).The intervention strategy primarily enhanced Boston scores in patients using sodium phosphate, magnesium sulfate with sodium potassium, or magnesium sulfate as bowel-cleansing agents, while also significantly reducing the incidence of adverse reactions compared to the control group (P < 0.01).Additionally, the intervention strategy significantly improved the detection rate of colonic lesions and patients′ satisfaction (P < 0.05 and P < 0.01).
      Conclusions The individualized bowel preparation intervention strategy based on the TSHNA 0003-2023 group standard effectively improves the adequacy rate of bowel preparation for colonoscopy in outpatinents, reduces the incidence of adverse reactions, increases the detection rate of lesions, and enhances patients′ satisfaction.The strategy demonstrates significant clinical benefits and is worthy of widespread application and promotion.

       

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