直肠Miles术后经肠造口行结肠镜检查的配合方案构建及临床应用

Construction and Clinical Application of the Coordination Scheme of Transintestinal Stoma Colonos-copy after Rectal Miles Surgery

摘要: 目的：探讨直肠Miles术后经肠造口行结肠镜检查的配合方案构建及临床应用。方法：本院总结以往临床配合经验与护理，制定出一套电子结肠镜配合方案(后简称配合方案)并于2022年1月开始在临床中应用。回顾性搜集2020年1月~2021年12月应用配合方案之前在本院接受经结肠造口电子结肠镜诊疗的107例患者纳入应用前组，搜集2022年1月~2023年12月应用配合方案后，在本院接受经结肠造口电子结肠镜诊疗的149例患者纳入应用后组；对比两组患者肠道准备成功率、检查成功率，统计两组患者临床指标：到达回盲处时间、检查时间、进镜深度、疼痛程度；观察两组患者检查前与检查中的血流动力学指标：心率、收缩压、舒张压的变化情况及检查前、后心理状态变化情况；调查两组患者满意度。结果：应用后组肠道准备成功率、检查成功率均高于常规组，差异有统计学意义(P < 0.05)；两组进镜深度对比差异无统计学意义(P > 0.05)；应用后组到达回盲处时间、检查时间与疼痛程度均低于应用前组，差异均有统计学意义(P < 0.05)；术中应用后组患者心率、收缩压均低于应用前组，差异有统计学意义(P < 0.05)；术后，两组患者SAS、SDS评分均低于本组术前，应用后组均低于应用前组，差异均有统计学意义(P < 0.05)；应用后组患者总满意率与整体满意度均优于应用前组，差异有统计学意义(P < 0.05)。结论：总结以往临床经验与技巧制定的配合方案，能够减轻经结肠造口行电子结肠镜检查患者的疼痛程度，提高检查效率与肠道准备成功率，改善患者心理状态、预防患者过度紧张从而全面提高了患者满意度。

Abstract: Objective: To discuss the construction and clinical application of the coordination scheme of transintestinal stoma colonoscopy after rectal Miles surgery. Methods: A set of electronic colonoscopy coordination programs (hereafter referred to as coordination program) was developed by our hospital based on previous clinical coordination experience and skills, and was applied in the clinic from January 2022. A total of 107 patients who received electronic colonoscopy via colostomy in our hospital before the application of the coordination regimen from January 2020 to December 2021 were retrospectively collected and included in the pre-application group; 149 patients who received electronic colonoscopy via colostomy in our hospital after the application of the coordination regimen from January 2022 to December 2023 were collected and included in the post-application group. The success rate of intestinal preparation and examination were compared between the two groups, and the clinical indicators of the two groups were counted: arrival time at the ileocecal site, examination time, depth of endoscopy and pain degree; Hemodynamic indexes were observed before and during the examination, including heart rate, systolic blood pressure and diastolic blood pressure, as well as psychological state changes before and after examination. The satisfaction of patients in both groups was investigated. Results: After application, the success rate of intestinal preparation and examination in the group were higher than those in the conventional group, and the difference was statistically significant (P < 0.05). There was no significant difference between the two groups in endoscopic depth (P > 0.05). After application, the time to ileocecal area, examination time and pain degree were lower than those before application, and the differences were statistically significant (P < 0.05). The heart rate and systolic blood pressure in the group after intraoperative application were lower than those in the group before application, with statistical significance (P < 0.05). After surgery, SAS and SDS scores of 2 groups were lower than those of this group before surgery, and the group after application was lower than that before application, the differences were statistically significant (P < 0.05). The total satisfaction rate and overall satisfaction of patients in the group after application were better than those in the group before application, with statistical significance (P < 0.05). Conclusion: Based on the previous clinical experience and skills, the coordination plan can reduce the pain degree of patients undergoing electronic colonoscopy through colostomy, improve the efficiency of examination and the success rate of intestinal preparation, improve the psychological state of patients, prevent patients from excessive tension, and comprehensively improve patient satisfaction.