[急诊结肠镜检查在不同肠道清洁度患者严重急性下消化道出血诊断中的价值]
[Value of urgent colonoscopy in diagnosis of severe acute lower gastrointestinal bleeding in patients with different bowel cleanliness].
作者信息
Li Jing, Tang Jin, Chen Ye, Zhi Fa-Chao, Liu Si-de, He Mei-Rong
机构信息
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2016 Apr 20;37(4):522-527. doi: 10.3969/j.issn.1673-4254.2017.04.17.
OBJECTIVE
To investigate the value of urgent colonoscopy in the diagnosis of severe acute lower gastrointestinal bleeding and the optimal bowel preparation before examination.
METHODS
The clinical data were collected from 188 patients undergoing wither urgent or elective colonoscopy for severe acute lower gastrointestinal bleeding in Nanfang Hospital. Univariate analysis was used to assess the effect of the timing of colonoscopy on the diagnostic rate of hemorrhage, and a multivariate model which stratified bowel cleanliness was used to analyze the impact of bowel cleanliness on the diagnostic rate of urgent colonoscopy.
RESULTS
Of the 188 patients, 118 underwent urgent colonoscopy and 70 underwent elective colonoscopy examinations. The diagnostic rates were comparable between the two groups (44.1% vs 41.4%, P=0.724), but urgent colonoscopy resulted in a significantly higher diagnostic rate for identifying the bleeding source (32.2% vs 18.6%, P=0.041). The proportion of the patients taking oral laxatives was significantly lower in urgent colonoscopy group (P<0.001). Oral laxatives versus enema resulted in good, moderate, and poor bowel cleanliness in 63.6% vs 13.5%, 28.6% vs 24.3%, and 7.8% vs 62.2% of the patients (P<0.001). Univariate analysis indicated that good bowel cleanliness was associated with a significantly higher diagnostic rate of colonoscopy than poor bowel cleanliness (P=0.012). Multivariate analysis showed that with good bowel cleanliness, urgent colonoscopy yielded a significantly higher diagnostic rate than elective colonoscopy (P=0.030); subgroup analyses suggested that good bowel cleanliness improved the diagnostic rate of urgent colonoscopy as compared with poor bowel cleanliness (P=0.015).
CONCLUSION
In patients with good bowel cleanliness, urgent colonoscopy yields a higher diagnostic rate than elective colonoscopy for severe acute lower gastrointestinal bleeding. Poor bowel cleanliness resulting from bowel preparation by enema significantly lowers the diagnostic performance of urgent colonoscopy. Oral laxatives are recommended over enemas for bowel preparation before urgent colonoscopy when the patients have stable hemodynamics.
目的
探讨急诊结肠镜检查在严重急性下消化道出血诊断中的价值及检查前最佳肠道准备方法。
方法
收集南方医院188例因严重急性下消化道出血接受急诊或择期结肠镜检查患者的临床资料。采用单因素分析评估结肠镜检查时机对出血诊断率的影响，运用分层肠道清洁度的多因素模型分析肠道清洁度对急诊结肠镜检查诊断率的影响。
结果
188例患者中，118例行急诊结肠镜检查，70例行择期结肠镜检查。两组诊断率相当（44.1%对41.4%，P = 0.724），但急诊结肠镜检查在确定出血源方面诊断率显著更高（32.2%对18.6%，P = 0.041）。急诊结肠镜检查组口服泻药的患者比例显著更低（P < 0.001）。口服泻药与灌肠相比，患者肠道清洁度良好、中等及差的比例分别为63.6%对13.5%、28.6%对24.3%、7.8%对62.2%（P < 0.001）。单因素分析表明，肠道清洁度良好时结肠镜检查诊断率显著高于肠道清洁度差时（P = 0.012）。多因素分析显示，肠道清洁度良好时，急诊结肠镜检查诊断率显著高于择期结肠镜检查（P = 0.030）；亚组分析提示，与肠道清洁度差相比，肠道清洁度良好可提高急诊结肠镜检查诊断率（P = 0.015）。
结论
对于严重急性下消化道出血且肠道清洁度良好的患者，急诊结肠镜检查的诊断率高于择期结肠镜检查。灌肠进行肠道准备导致的肠道清洁度差会显著降低急诊结肠镜检查的诊断效能。当患者血流动力学稳定时，急诊结肠镜检查前推荐采用口服泻药而非灌肠进行肠道准备。
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