大腸鏡檢查前一日採低渣飲食對腸道準備的影響Effectiveness of a low-residue diet administered one day before colonoscopy on bowel preparation

1775 3 201         DOI:doi.org/10.30131/TWNA_EBHC_Library.DB_2022030001B/Text

2022-05-20 已刊登
綜 整 預防/治療/介入類型

作  者

察芳瑜 蘇婷安 高淨萍 黃珈綺 吳雅萍 戴佳惠*

文章類別

B 類:實證健康照護應用

問題類型

治療/預防性問題

健康狀況

胃腸肝臟系統 (Gastroenterology and Hepatology)  

治療/介入措施

臨床護理技術相關措施(Clinical Nursing Skills and Techniques) - 低渣飲食

專長類別

消化、內分泌

中文關鍵詞

#大腸鏡檢查 #低渣飲食 #清流飲食 #腸道準備 #腸道清潔度

英文關鍵詞

#colonoscopy #low-residue diet #clear liquid diet #bowel preparation #bowel cleanliness

機構名稱

佛教慈濟醫療財團法人花蓮慈濟醫院

申請單位

護理部

中文摘要

形成臨床提問:
大腸鏡檢查是診斷、預防及治療大腸癌的方式。腸道準備不足會降低腸道清潔度,進而影響檢查品質。腸道準備需要配合清腸劑服用、飲食限制及足夠禁食時間,且配合檢查時間執行,被病人視為重要的障礙。作者臨床觀察護理師指導病人,在大腸鏡檢查前一日採用清流飲食,部分病人反應有飢餓故拒絕清流飲食而是持續原本的低渣飲食,大腸鏡檢查順利完成,腸道清潔度也顯示合格。故引發作者探討低渣飲食與清流飲食對於腸道準備之影響及實證證據等級,期能提升病人在大腸鏡檢查腸道準備的配合狀況。
文獻搜尋的方法與分析:
依據實證5A進行。搜尋Cochrane library、PubMed、ClinicalKey醫學資料庫、UpToDate及華藝線上圖書館。搜尋結果共29篇,刪除重複文獻、非住院之成年患者、主題不符及研究設計不符合之文獻。檢視符合共計3篇,包含1篇SR及2篇RCT,2篇RCT未被收錄於SR內。
文獻的品質評讀與結果:
文獻評估工具採用CASP之系統性文獻回顧檢核表及隨機控制試驗檢核表,進行三大面向評讀。採用牛津大學實證醫學中心建議的臨床研究證據等級,文獻一內容聚焦、有作統合分析及偏誤風險,可被臨床使用故評比為Level I;文獻二及文獻三收案過程雖然因為治療效益關係無法盲化飲食內容,但盲化飲食內容在研究設計上有困難,研究設計上讓進行檢查的醫師盲化已將偏差風險降低,故將2篇RCT評比為Level II。三篇文獻的主要結果,大腸鏡檢查前一日採清流飲食或低渣飲食,兩者腸道清潔度無顯著差異。但飽足感及耐受性,低渣飲食是優於清流飲食的。
證據之臨床應用:
臨床應用依據文獻建議將大腸鏡檢查前一日飲食調整為低渣飲食,並比較兩種飲食對於腸道準備的影響。其餘腸道準備項目不變。若主治醫師評估病人不適合則維持檢查前一日採清流飲食。推行前先完成低渣飲食界定、腸道準備教育訓練、護理師口袋書修訂及衛教單張修訂等,最後進行低渣飲食與清流飲食對於腸道準備的影響比較。
成效評值:
2020年01月至12月共計收案110位入住腸胃科病房且需執行大腸鏡檢查的成年病人,分析低渣飲食或清流飲食對於腸道準備的影響。病人年齡介於22-96歲,平均年齡61.8 ± 16.3歲,男性71位(64.5%)。病人皆使用同一種清腸劑,禁食時間皆為6-8小時。整體腸道準備完整率87.3%,腸道清潔度合格率68.2%,沒有發生二次受檢的狀況。以統計檢定分析兩組在性別、年齡兩組無顯著差異。兩組腸道準備完整性及腸道清潔度皆無顯著差異。
結論與建議:
依據文獻評讀及臨床應用成果顯示,大腸鏡檢查前一日使用低渣飲食或清流飲食,對腸道清潔度無顯著影響。但低渣飲食可以減少腸道準備期間的飢餓感,此策略視為可行之策略,並持續推展中。臨床在推動腸道準備過程,一併進行作業標準更新,腸道準備教育訓練、護理師口袋書修訂及大腸鏡檢查衛教單張的優化等。最終增加護理師執行腸道準備的完整性及病人腸道準備的配合度。

英文摘要

Ask an answerable question (PICO):
Colonoscopy is a method for diagnosing, preventing, and treating colon cancer. Insufficient bowel preparation may decrease bowel cleanliness, thereby affecting colonoscopy quality. Bowel preparation involves the administration of cathartics and ensuring sufficient food intake and fasting duration; however, these functions must be performed according to the examination time, which is considered as an important obstacle by patients. The author observed that clinical nurses would instruct patients to follow a clear liquid diet one day before colonoscopy. However, some patients refused to follow the clear liquid diet due to hunger and continued with the original low-residue diet. Despite this, colonoscopy could still be successfully performed, and adequate bowel cleanliness was also achieved. This triggered the author to examine the effectiveness of a low-residue diet and a clear liquid diet on bowel preparation and level of evidence to improve patient compliance for colonoscopy preparation.
The Method and Analysis of Literature Review:
Five steps of an evidence-based process were followed to determine an answerable question. We searched Cochrane library, PubMed, ClinicalKey medical database, UpToDate, and Airiti Library to find articles that conformed to PICO by using MeSH terms, synonyms, and truncated words for each element of PICO. Searched 29 articles in total. Duplicate articles were deleted, and articles that were not related to the subject, non-hospitalized adult patients that were inconsistent with the subject and the study design were excluded. Including one systematic review (SR) and two randomized controlled trials (RCTs), 2 RCTs are not included in the SR.
Critical Appraisal:
The literature evaluation tool uses CASP's systematic literature review checklist and randomized controlled trial checklist to conduct three-dimensional evaluation. The clinical research evidence level recommended by the Centre for Evidence-Based Medicine in Oxford University is adopted. Literature 1 is focused on content, has integrated analysis and risk of error, and can be used clinically, so it is rated as Level 1. Although Literature 2 and Literature 3 cannot blindly blind the diet content due to the treatment benefit, the blind diet content is difficult in research design. In the research design, blinding the doctor performing the examination has reduced the risk of deviation, so the evaluation is as follows: Level II. Based on the major findings in the three papers, there was no significant difference observed in bowel cleanliness between patients who followed a clear liquid diet and those who followed a low-residue diet for colonoscopy preparation. However, a low-residue diet was determined to be better than a clear liquid diet in terms of satiety and tolerability.
Clinical Application of Evidence:
After a discussion on clinical optimization, the diet was changed to a low-residue diet one day before colonoscopy based on literature recommendations, and the effects of the two types of diet on bowel preparation were compared. In the adjusted bowel preparation content, only the diet on the day before the examination was changed to a low-residue one and other bowel preparation items remained unchanged. If the attending physician determined that the patient was not suitable for a low-residue diet, then a clear liquid diet was administered one day before examination. Before the promotion, nurse education and training and health education revisions were performed.
Evaluation of Effectiveness:
From January to December 2020, a total of 110 patients were admitted to the gastroenterology ward and required colonoscopy. The effects of a low-residue diet and clear liquid diet on bowel preparation were examined. The study subjects, of whom 71 were males (64.5%), were aged between 22 and 90 years with a mean age of 61.8±16.3 years. The bowel preparation completion rate was 87.3%, bowel cleanliness conformance was 68.2%, and no other second examination was carried out. Statistical tests was used to analyze whether there were significant differences in gender and age between the two groups. There were no significant difference in bowel preparation completion and bowel cleanliness.
Conclusions and Recommendations:
The literature review results and clinical application results showed that a low-residue diet and a clear liquid diet one day before colonoscopy did not significantly affect bowel cleanliness. However, the low-residue diet could reduce hunger during bowel preparation, thereby increasing patient compliance, This strategy is regarded as a feasible strategy and is being continuously implemented. In addition to updating the bowel preparation procedure, education Training, updating health education leaflets, and revising nurses’ pocket editions in clinical promotion can increase bowel preparation completeness and patient compliance when nurses perform bowel preparation.