高原地区结肠镜检查质量临床观察及干预对策分析
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青海省人民医院消化科

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中国肝炎防治基金会天晴肝病研究基金(TQGB20140260)


Colonoscopy quality and intervention strategy in plateau area
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    摘要:

    目的分析高原环境对结肠镜检查质量的影响。方法收集2016年1月—2018年5月在青海省人民医院完成结肠镜检查且结果无异常的450例健康体检者资料。根据患者居住地区海拔高度,分为对照组(海拔>1 500~<2 500 m,120例)、高海拔组(海拔2 500~<3 500 m,170例)、超高海拔组(海拔3 500~<5 500 m,160例),分析进镜时间、退镜时间、结肠清洁率、盲肠达镜率、镜检过程中腹痛腹胀症状等指标与海拔的关系。结果对照组、高海拔组和超高海拔组平均进镜时间为9.23 min、17.69 min和24.51 min,多元回归分析发现,高海拔组比对照组平均延长8.20 min,超高海拔组比对照组平均延长15.11 min(P<0.001)。对照组、高海拔组和超高海拔组平均退镜时间为7.17 min、7.28 min和7.93 min,多元回归分析发现,高海拔组与对照组比较差异无统计学意义(P>0.05),但超高海拔组相比对照组延长了0.76 min(P<0.001)。对照组、高海拔组和超高海拔组的肠道清洁优良率分别为41.7%(50/120)、17.6%(30/170)和12.5%(20/160),Logistic回归分析发现,高海拔组比对照组肠道清洁程度下降一个等级的可能性增加1.96倍,超高海拔组比对照组肠道清洁程度下降一个等级的可能性增加8.76倍(P<0.001)。对照组、高海拔组和超高海拔组盲肠达镜率分别为91.7%(110/120)、85.9%(146/170)和81.2%(130/160),高海拔组与对照组比较差异无统计学意义(P>0.05),超高海拔组与对照组比较差异有统计学意义(OR=0.38,95%CI:0.17~0.82,P=0.015)。随着患者居住地海拔升高,结肠镜检查中患者腹痛、腹胀等症状逐渐加重,3组间差异有统计学意义(P<0.05)。结论高原地区结肠镜检查质量低,检查前选择性干预可提高高原地区结肠镜检查质量。

    Abstract:

    Objective Through clinical observation of colonoscopy quality in plateau area, the influencing factors of colonoscopy quality in plateau environment were analyzed to provide clinical basis for intervention strategy. Methods Data from 450 patients living in different altitudes without abnormal colonoscopy results were collected from January 2016 to May 2018 in Endoscopy center, Qinghai provincial people"s hospital, and colonoscopy observation factors such as abdominal pain, abdominal distension, duration of colonoscopy entry and withdrawal, colonoscopy rate of cecum, and colon cleanliness rate were analyzed. Results (1) In contrast to the control group altitude(1500m-2500m), the duration colonoscopy entry is extending by the increasing of the elevations. By the multiple regression analysis, the duration colonoscopy entry of the high altitude (2500-3500m) group and super high altitude (3500m-5500m) group is extending 8.20 min and 15.11 min more than the controlled respectively in average (P<0.001). The duration of colonoscopy withdrawal is extending by the increasing of the elevations. However, the high-altitude group is not distinctly higher than the control, but the super high-altitude group is extending 0.76 min more than the group (P<0.001). (2) In contrast to the control, the possibility of colon cleanliness degrading of the high-altitude group and the super high-altitude group is increasing by 1.96 folds and 8.76 folds. (3) The colonoscopy rate of cecum of the high altitude group is not distinctly different from the control, but that of the super high altitude group is 81.2% with a OR value of 0.38 (95%CI:0.17~0.82,P=0.015) comparing with the control. (4) The abdominal pain and distension are becoming severer by the elevation increasing statistically. Conclusion Colonoscopy in plateau regions confront difficulties such as the longer duration of colonoscopy entry and withdraw, colon cleanliness decreasing, cecum rate affecting, as well as uncomfortable symptoms (abdominal pain and distension) accompanying. Therefore, selective intervention before examination may improve the quality of colonoscopy in plateau areas.

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李萍英,李娟,杨永耿,等.高原地区结肠镜检查质量临床观察及干预对策分析[J].中华消化内镜杂志,2020,37(7):510-513.

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  • 收稿日期:2019-04-22
  • 最后修改日期:2020-03-23
  • 录用日期:2019-09-16
  • 在线发布日期: 2020-07-29
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