大肠癌结肠镜检查与分析

目的探讨结肠镜检查大肠癌患者的发病情况及发病率。方法本组资料源于我院2013年1月至2014年6月结肠镜检查并经病理活检确诊的58例大肠癌患者。所有受检者均在电子结肠镜下观察,对有溃疡、肿块、糜烂、狭窄等肿瘤病灶部位取活检行病理诊断,明确组织类型。结果 58例大肠癌患者就诊时主要症状腹痛15例,肉眼血便10例,腹泻3例,腹部包块2例,贫血1例;所有患者粪便潜血实验阳性46例;直肠39例,左半结肠9例,右半结肠10例;溃疡型22例,肿块型27例,浸润型9例;腺癌56例,黏液腺癌2例。结论兴山县大肠癌肠镜检出率相对较高,发病部位以直肠为主,本地区应大力开展大肠癌早期诊断、早期治疗工作。     

丙泊酚复合利多卡因静脉麻醉在高血压患者结肠镜检查中的应用

目的探讨丙泊酚复合利多卡因静脉麻醉在高血压患者结肠镜检查中的安全性及效果。方法回顾性分析47例高血压患者的结肠镜检查资料,将其分为常规组、无痛组。无痛组静脉缓慢注射丙泊酚和利多卡因混合液,使患者入睡后进镜检查。监测并记录两组在检查前、检查中、检查后的收缩压、舒张压、心率、血氧饱和度及镜检时间。无痛组记录麻醉诱导时间、苏醒时间、计算力及提问对答恢复正常时间。结果无痛组全部到达检查终点,常规组有2例未达到回盲部;无痛组镜检时间明显低于常规组,两组比较差异有统计学意义(P<0.05);无痛组的收缩压、舒张压、心率在检查中较检查前明显下降(P<0.05);常规组收缩压、舒张压、心率在检查中比检查前明显增高(P<0.05);两组检查结束后收缩压、舒张压、心率均恢复至检查前水平;血氧饱和度在两组的各个检查中无明显变化。无痛组麻醉诱导时间为(1.9±0.6)min、清醒时间为(6±5)min,计算力及提问对答恢复正常时间为(6±5)min。结论应用丙泊酚复合利多卡因静脉麻醉对高血压患者进行无痛结肠镜检查是可靠的。     

Cost-analysis model of colonoscopy preparation using split-dose reduced-volume oral sulfate solution (OSS) and polyethylene glycol with electrolytes solution (PEG-ELS)

Objective:

The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model.

Methods:

Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010–Q12013. In the model, patients’ colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model.

Results:

The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%.

Conclusions:

From a payer’s perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.     

护理干预对肠镜下结肠息肉切除效果的影响

目的探讨护理干预在肠镜下结肠息肉切除术中的临床应用效果。方法选取2013年3月～2013年6月在我院进行肠镜下结肠息肉切除手术治疗的患者350例,随机分为干预组和对照组各175例。两组患者在行肠镜下结肠息肉切除手术的同时,均给予一般常规护理干预模式,而干预组患者则在此基础上采用系统化的综合护理干预模式,并分别对两组患者的临床治疗情况进行深入细致的比较和分析。结果与对照组相比,干预组患者插镜成功的比率显著提高,而术后出现腹胀和肛门便意感的比率则显著降低,差别均具有统计学意义（P＜0.05）;与此同时,干预组患者术中发生肠穿孔和肠出血的比率均有所减少,但均未呈现出显著性差异（P＞0.05）。结论系统性综合护理干预模式对于肠镜下结肠息肉切除手术患者临床治疗效果的改善及并发症的减少均具有极其重要的意义,适于临床推广和应用。