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编者按 结肠镜检查的诊断准确性和操作安全性取决于肠道准备的质量，在传统的肠道准备过程中，患者常常会处于半禁食状态，从而加重患者的营养不良状态。目前，结肠镜准备过程中的营养缺乏状况仍是未知的，对于临床结局的影响也未有研究报道。为了量化结肠镜准备过程中的营养缺乏状况，研究者通过随机抽样，采用人体测量的方法来计算营养缺乏的情况，以了解结肠镜检查患者的营养状况。研究发现，结肠镜检查准备过程中患者营养缺乏的情况显著，尤其是老年患者。营养缺乏与肠道准备的质量无关。研究者得出结论，应重新制定肠道准备方案，增加营养摄入和无残留的口服营养补充剂。 2.结肠镜准备过程中的营养缺乏:被遗忘的医源性 Nunes G, Barata AT, Santos CA, Rev Esp Enferm Dig. 2018 May;110(5):285-291. 摘要 背景和目的：结肠镜检查前行肠道准备需要患者处于半禁食状态。这对虚弱的患者来说有潜在的负面影响。本研究旨在量化评估肠道准备过程中患者营养缺乏状况。 方法：本研究为观察性和横断面研究。合适的样本来自于根据中心操作手册，采用Klean-Prep®行肠道准备后接受结肠镜检查的成人患者。进行人体测量评估，通过测量肠镜检查前48小时内的能量和蛋白质摄入量，与个体需求量进行比较，来定量计算患者营养不足的发生情况。评估了营养缺乏与肠道准备的质量、患者年龄和状态(住院/门诊)之间的关系。 结果：该研究纳入131例21~91岁(平均年龄63.6±13.2岁)的患者，其中男性73例。采用特定人体测量工具（Triceps skinfold, TSF），患者营养不良发生率达到67.2%。当采用波士顿肠道准备量表时，平均肠道准备质量评分为6分。肠镜检查前48小时平均摄入量为1795kcal和100g蛋白质。每日能量摄入不足个体需要量一半的患者有88例，每日能量摄入不足个体需要的25%的患者有29例。患者平均能量和蛋白缺乏发生率分别为59% (p < 0.01)和45% (p < 0.01)，与肠道准备质量无显著相关性(p > 0.05)。住院和门诊患者营养缺乏程度相似(p > 0.05)，但老年患者营养缺乏程度更高(p = 0.04)。 结论：结肠镜检查前，肠道准备过程中易造成营养缺乏，老年患者更加明显，营养缺乏与肠道准备质量好坏无显著相关性。我们的结论是，肠道准备方案应重新制定，增加营养摄入，包括增加无残留的营养补充剂。 文献相关表格： 2.Nutritional deficiency during colonoscopy preparation: the forgotten iatrogeny Nunes G, Barata AT, Santos CA, Rev Esp Enferm Dig. 2018 May;110(5):285-291. Abstract Background And Aims: Bowel preparation for colonoscopy induces a semi-fasting state, with a potential negative impact on fragile patients. The present study aims to quantify nutritional deficiency during colonoscopy preparation. Methods:This was an observational and cross-sectional study. A convenience sample was obtained that included adults that underwent colonoscopy after bowel preparation with Klean-Prep® according to the center protocol. Anthropometric evaluation was performed and nutritional deficiency was calculated via the quantification of energy and protein intake during the 48 hours prior to the examination which was compared with the individuals' needs. The association between nutritional deficiency with the quality of bowel preparation, age and status (hospitalized/ambulatory) was evaluated. Results:The study included 131 patients aged 21-91 years (mean 63.6 ± 13.2 years); 73 cases were male. Malnutrition reached 67.2% using specific anthropometric tools. A median preparation quality of six points was found when the Boston Bowel Preparation Scale was considered. The mean intake 48 hours prior to the procedure was 1,795 kcal and 100 g of protein. A daily energy intake of less than 50% of the individual needs was observed in 88 patients and less than 25% in 29 cases. The mean energy and protein deficiency were 59% (p < 0.01) and 45% (p < 0.01), and there was no correlation with preparation quality (p > 0.05). Nutritional defiency is similar in hospitalized and ambulatory patients (p > 0.05), but higher in older individuals (p = 0.04). Conclusions:Nutritional deficiency during colonoscopy preparation was significant, more so in older patients, and there was no correlation with the quality of bowel preparation. We conclude that bowel preparation regimens should be reformulated with an improved nutritional intake and the inclusion of nutritional supplements without residues. 仅供学习参考
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