影响住院行结肠镜诊疗老年患者肠道准备质量的主要因素及其参考界值分析

 目的 探讨影响住院行结肠镜诊疗老年患者肠道准备质量的主要因素,分析相应因素下肠道准备不充分的风险分级及参考界值。方法 回顾性分析在解放军总医院第二医学中心住院行结肠镜诊疗的患者病例资料,包括基本资料、基础疾病、肠道准备相关情况及肠道准备质量,采用病例对照研究,进行单因素分析及多因素回归分析探讨肠道准备质量的影响因素。结果 共160例患者纳入研究,肠道准备合格率为71.25%,多因素回归分析显示,年龄(OR=0.899,P＜0.001)、排便次数(OR=2.223,P＜0.001)及肠道准备方案(OR=0.275,P=0.007)是老年住院行结肠镜诊疗患者肠道准备质量的独立影响因素。进一步分层分析,＜60岁、60～79岁、≥80岁各年龄段肠道准备合格率递减,排便次数＜5次、5～6次、≥7次各段肠道准备合格率明显递增。结论 以60岁和80岁为肠道准备不充分的风险预测参考界值,随着年龄增长肠道准备不充分的风险倍增;肠道准备合格率随排便次数增多而升高,以排便5次和7次划分肠道准备不充分的风险等级具有临床价值;分次肠道准备方案能提高肠道准备的质量。

Influencing factors of bowel preparation before colonoscopy in elderly inpatients

Objective To explore main factors that may potentially contribute to inadequate bowel preparation before colonoscopy in elderly inpatients, and to find out more about the best cut-off values of these factors in risk stratification.Methods A total of 160 elderly inpatients subjected to colonoscopy in the Department of Gastroenterology between September 1,2019 and September 1,2019 were enrolled in this study. Their demographical information, comorbidities, quality of bowel preparation and morphological identification of the last stool were recorded and collected. Univariate and multivariate regression analysis was used to analyze the factors that affected bowel preparation.Results 71.25 percent of the these patients were under adequate bowel preparation. Multivariate regression analysis showed that age (OR=0.899,P＜0.001),defecation frequency (OR=2.223,P＜0.001) and bowel preparation protocols (OR=0.275,P=0.007) were independent risk factors for inadequate bowel preparation in elderly inpatients.Further subgroup analysis found the rate of adequate bowl preparation decreased in age groups of less than 60 years old, 60 to 79 years old and over 80 years old in particular, while defecation at the frequency of less than 5 times,5 to 6 times and over 7 times seemed to contribute to the quality of bowel preparation.Conclusions Inadequate bowel preparation remains a concern among elderly inpatients. Age and defecation frequency are two factors that may independently affect the quality of bowel preparation among these patients. The quality of bowel preparation might be improved by staged preparation.