Cohen S M, Wexner S D, Binderow S R, Nogueras J J, Daniel N, Ehrenpreis E D, Jensen J, Bonner G F, Ruderman W B
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309-1743.
Dis Colon Rectum. 1994 Jul;37(7):689-96. doi: 10.1007/BF02054413.
Recent reports have suggested that precolonoscopy bowel preparation is easier to tolerate if a small volume solution is used. Therefore, the aim of this study was to compare three oral solutions for colonoscopy to determine any changes in either patient compliance or cleansing ability.
Four hundred fifty patients were prospectively randomized to receive either a standard 4-liter polyethylene glycol solution, a newer sulfate-free 4-liter polyethylene glycol solution, or a 90-ml oral sodium phosphate preparation. Before and after bowel preparation all patients were weighed, and serum electrolytes as well as phosphate, magnesium, calcium, and osmolarity were measured. In addition, a detailed questionnaire was used to assess side effects and patient satisfaction. Endoscopists blinded to the type and quantity of preparation used scored the type of residual stool and the percentage of bowel wall visualized for each segment of colon and for the overall examination. Nurses recorded all procedure times as well as the quantity of irrigation and aspiration.
Four hundred twenty-two age-matched and sex-matched patients completed all phases of the trial. There were no clinically significant changes in weight or in any biochemical parameters. There was, however, asymptomatic hyperphosphatemia in the sodium phosphate group (P < 0.01). The length of time to the cecum was similar for all three groups, with a higher volume of fluid suctioned for sodium phosphate (P < 0.01). Overall, endoscopists scored sodium phosphate as "excellent" or "good" in 90 percent vs. 70 percent and 73 percent after the polyethylene glycol or sulfate-free lavage, respectively (P < 0.01). Particulate or solid stool was found in all segments of the colon more frequently after both large volume preparations than after sodium phosphate (P < 0.05). There were no significant differences in the frequency or intensity of any of the 11 side effects questioned. Eighty-three percent of the patients who received the sodium phosphate preparation stated they would take this same preparation again, vs. only 19 percent and 33 percent for polyethylene glycol and the sulfate-free lavage, respectively (P < 0.01).
The smaller volume oral sodium phosphate was not associated with any clinically significant problem, caused no increase in the incidence of side effects, was preferred by patients, and was more effective in colonic cleansing. However, the hyperphosphatemia seen may limit its use in patients with impaired renal function.
近期报告表明，若使用小容量溶液，结肠镜检查前的肠道准备更易于耐受。因此，本研究旨在比较三种用于结肠镜检查的口服溶液，以确定患者依从性或清洁能力是否有任何变化。
450例患者被前瞻性随机分组，分别接受标准的4升聚乙二醇溶液、新型无硫酸盐的4升聚乙二醇溶液或90毫升口服磷酸钠制剂。肠道准备前后对所有患者进行称重，并测量血清电解质以及磷酸盐、镁、钙和渗透压。此外，使用详细问卷评估副作用和患者满意度。对所用制剂的类型和数量不知情的内镜医师对残留粪便的类型以及结肠各段和整个检查中可见肠壁的百分比进行评分。护士记录所有操作时间以及冲洗和抽吸的量。
422例年龄和性别匹配的患者完成了试验的所有阶段。体重或任何生化参数均无临床显著变化。然而，磷酸钠组出现无症状高磷血症（P<0.01）。三组到达盲肠的时间相似，但磷酸钠组抽吸的液体量更多（P<0.01）。总体而言，内镜医师将磷酸钠评为“优秀”或“良好”的比例为90%，而聚乙二醇或无硫酸盐灌洗后分别为70%和73%（P<0.01）。与磷酸钠相比，两种大容量制剂后结肠各段更频繁地发现颗粒状或固体粪便（P<0.05）。所询问的11种副作用的频率或强度均无显著差异。接受磷酸钠制剂的患者中有83%表示会再次使用相同制剂，而聚乙二醇和无硫酸盐灌洗组分别仅为19%和33%（P<0.01）。
较小容量的口服磷酸钠未出现任何临床显著问题，未增加副作用发生率，受患者青睐，且在结肠清洁方面更有效。然而，所观察到的高磷血症可能会限制其在肾功能受损患者中的使用。
