儿童结肠镜检查前聚乙二醇电解质散联合饮食控制肠道准备质量的影响因素分析

Influencing factors for the quality of bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy in children

摘要:

目的 探讨儿童结肠镜检查前肠道准备质量的影响因素，以及末次服完泻药至开始结肠镜检查的时间间隔（简称等待时间）与肠道准备质量的关系。 方法 回顾性分析2020年1~11月入住南京医科大学附属儿童医院消化科使用聚乙二醇电解质散联合饮食控制进行肠道准备并行结肠镜检查的患儿，按照Boston肠道准备评分分为肠道准备充分组（337例）和肠道准备不充分组（30例）。收集两组患儿的一般资料、肠道准备质量可能的影响因素、肠道准备相关的不良反应、结肠镜检查持续时间、术后诊断等，采用单因素及多因素分析探索肠道准备质量的影响因素。 结果 单因素分析显示，年龄、体重、等待时间与肠道准备不充分有关（均P<0.05）。多因素分析显示年龄大（OR=2.155，95%CI：1.087~4.273，P=0.028）及等待时间长（OR=1.559，95%CI：1.191~2.041，P=0.001）是儿童肠道准备不充分的独立危险因素。受试者工作特征曲线分析显示等待时间区分肠道准备充分与否的临界值为5.5 h（灵敏度、特异度分别为90.0%、50.7%；曲线下面积为0.708）。进一步按不同等待时间分组，发现≥5.5 h组肠道准备不充分的发生率明显高于<5.5 h组［（27/193，14.0%）vs（3/174，1.7%），P<0.001］。 结论 使用聚乙二醇电解质散联合饮食控制进行肠道准备的患儿中，年龄大是结肠镜检查前肠道准备不充分的独立危险因素，可能与较大儿童存在聚乙二醇剂量不足有关。等待时间长亦是肠道准备不充分的独立危险因素，建议等待时间不要超过5.5 h。

Abstract:

Objective To investigate the influencing factors for the quality of bowel preparation before colonoscopy in children and the association of the interval from the last administration of laxative to the start of colonoscopy (shortly referred to as waiting time) with the quality of bowel preparation. Methods A retrospective analysis was performed for the children who were admitted to the Department of Gastroenterology, Children's Hospital of Nanjing Medical University, from January to November 2020, and received bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy. According to the score of Boston bowel preparation scale, they were divided into two groups: adequate bowel preparation group (n=337) and inadequate bowel preparation group (n=30). Related data were collected from the children in both groups, including general information, possible influencing factors for the quality of bowel preparation, adverse reactions associated with bowel preparation, duration of colonoscopy, and postoperative diagnosis. Univariate and multivariate analyses were used to explore the influencing factors for the quality of bowel preparation. Results The univariate analysis showed that age, body weight, and waiting time were associated with inadequate bowel preparation (P<0.05). The multivariate analysis showed that older age (OR=2.155, 95%CI: 1.087-4.273, P=0.028) and longer waiting time (OR=1.559, 95% CI: 1.191-2.041, P=0.001) were independent risk factors for inadequate bowel preparation. The receiver operating characteristic (ROC) curve analysis showed that the cut-off value of waiting time was 5.5 hours in determining whether bowel preparation was adequate or not, with a sensitivity of 90.0%, a specificity of 50.7%, and an area under the ROC curve of 0.708. After grouping based on waiting time, it was found that the incidence rate of inadequate bowel preparation in the ≥5.5 hours group was significantly higher than that in the <5.5 hours group [14.0% (27/193) vs 1.7% (3/174), P<0.001]. Conclusions For children who use polyethylene glycol electrolyte powder combined with diet control for bowel preparation, older age is an independent risk factor for inadequate bowel preparation before colonoscopy, which may be associated with an insufficient dose of polyethylene glycol in older children. Longer waiting time is also an independent risk factor for inadequate bowel preparation, and it is recommended that the waiting time should not exceed 5.5 hours.