Construction And Application Of Bowel Preparation Guidance Scheme That Based On The Principle Of Key-point Control For Elderly Patients With Colonoscopy

Objective.The purpose of this study is to construct and evaluate the bowel preparation guidance scheme that based on the principle of key-point control for elderly patients with colonoscopy,in order to explore the impact of the scheme on intestinal cleanliness,bowel preparation compliance and satisfaction,incidence of adverse reactions during bowel preparation and other outcome indicators in elderly patients undergoing colonoscopy,so as to provide reference for the implementation of scientific and standardized bowel preparation guidance.Methods.This study is divided into two parts.1 Construct bowel preparation guidance scheme that based on the principle of key-point control for elderly patients with colonoscopy:Guided by the principle of key-point control,we based on investigation of the quality of bowel preparation in 240 elderly patients with colonoscopy,qualitative interview for the compliance of intestinal preparation in 14 elderly patients with colonoscopy,dynamic recording of the detailed bowel preparation process in 6 elderly patients with colonoscopy,informing of bowel preparation in a number of third-grade class-A hospital,and bowel preparation guidance scheme for elderly patients with colonoscopy was constructed preliminary.Then after two rounds of Delphi expert consultation,bowel preparation guidance scheme for elderly patients with colonoscopy was constructed finally.2 Evaluate bowel preparation guidance scheme that based on the principle of key-point control for elderly patients with colonoscopy:Conduct a prospective,controlled study on the elderly patients with colonoscopy.According to inclusion and exclusion criteria,221 elderly patients with an appointment for colonoscopy were enrolled and divided into two groups according to the time of study.Finally,the elderly patients undergoing colonoscopy were 103 cases in the control group and the intervention grouprespectively.The control group was given routine bowel preparation guidance at the time of appointment,including the importance of bowel preparation,specific bowel preparation process and methods,possible side effects and treatment methods during preparation.Based on the routine bowel preparation guidance,the intervention group was given the key-point guidelines of bowel preparation,in order to explore the impact of the scheme on patients' intestinal cleanliness,bowel preparation compliance and satisfaction,incidence of adverse reactions during bowel preparation and other outcome indicators in elderly patients undergoing colonoscopy.All data were recorded in SPSS20.0 for statistics and analysis.Results.1 The key-point guidelines of bowel preparation included 3 key points for bowel preparation((1)Diet preparation;(2)Medicine and activity preparation;(3)Judgment of intestinal cleanliness and remedy for inadequate bowel preparation),4 key guidance moments(8 a.m.1 days before colonoscopy;7 p.m.1 days before the colonoscopy;4h before colonoscopy;1h before colonoscopy),7 key guidance contents,4 criteria for the process of bowel preparation and the corresponding remedial measures.2.Evaluate bowel preparation guidance scheme that based on the principle of key point control for elderly patients with colonoscopy:The statistics test of general data showed no significant difference between the control group and the intervention group(P >0.05).The results showed that the rate of adequate bowel preparation and OBPS total score of the patients in the intervention group were better than those in the control group,and the difference was statistically significant(P<0.01).The insertion time of the patients in the intervention group was shorter than those in the control group(P<0.01),but there was no significant difference between the two groups in the examination results(P>0.05).The proportion of the patients who non-compliance with dietary instructions,non-compliance with polyethylene glycol(PEG)dosage and non-compliance with exercise time in the intervention group was lower than those in the control group(P<0.01).In addition,the proportion of patients with nausea and abdominal distention in the intervention group was much lower than those in the control group,and the difference was statistically significant(P<0.01).However,there was no significant difference between the two groups in the incidence of vomiting,abdominal pain and dizziness(P>0.05).The overall satisfaction of bowel preparation and the willingness to repeat colonoscopy in the intervention group were significantly better than those in the control group,the differences were statistically significant(P<0.01).Conclusion.According to the key-point guidelines of bowel preparation to give guidance for elderly patients can effectively improve the adequate rate of bowel preparation,shorten the time of insertion,improve the compliance of bowel preparation,reduce the incidence of adverse reactions and improve patients' satisfaction with bowel preparation and the willingness to receive colonoscopy again.The intervention scheme provide a reference for the clinical implementation of standardized bowel preparation guidance and the content of the scheme is highly consistent with the actual needs of the elderly patients with colonoscopy,which is convenient for the implementation and has good clinical practical value.