磷酸鈉法與聚乙二醇電解質液法在結腸鏡檢前腸道準備中應用效果的系統評價_《中國循證醫學雜志》

作者：

李耀東 , 王一平 , 潘濤 , 田玲

四川大學華西醫院消化內科,成都,610041;

關鍵詞：

磷酸鈉聚乙二醇電解質液結腸鏡檢系統評價

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目的　系統評價口服磷酸鈉法和口服聚乙二醇電解質洗腸液法在腸道清潔效果、患者的耐受性和安全性等方面的差異,進而為在我國臨床中推廣使用提供依據.
方法　應用國際Cochrane協作網系統評價方法對比較這兩種方法的隨機對照試驗進行系統評價.計算機檢索Cochrane圖書館(2004年第1期)、MEDLINE(1980～2004)、EMBASE(1984～2004)、中國生物醫學文獻數據庫(1978～2004),手工檢索有關的中文期刊.收集比較兩者的隨機對照試驗,兩名評價員獨立評價、提取資料.采用RevMan4.2軟件進行統計分析.
結果　有18篇隨機對照試驗共3 668例患者滿足納入標準.Meta分析結果顯示,在全結腸質量優良率方面,磷酸鈉片劑優于聚乙二醇電解質液[RR 1.08, 95%CI (1.02,1.15), P=0.01],磷酸鈉隔夜兩次給藥優于含硫的聚乙二醇電解質液[RR 1.27, 95%CI (1.06,1.52), P=0.009].與聚乙二醇電解質液相比,磷酸鈉溶液的右半結腸清潔質量優良率較低[RR 0.79, 95%CI (0.64,0.98), P=0.03].磷酸鈉組的腹痛[RR 0.84, 95%CI (0.72, 0.99)]、腹脹[RR 0.48, 95%CI (0.26,0.89)]、惡心發生率[RR 0.65, 95%CI (0.56,0.76)]、洗腸液未飲完率[RR 0.23, 95%CI (0.14,0.36)]及腸道準備容易接受率[RR 1.50, 95%CI (1.09,2.06)]優于聚乙二醇電解質液組(P lt;0.05).
結論　與聚乙二醇電解質液相比,口服磷酸鈉有較好的清潔有效性、耐受性和安全性,較經濟,可在我國臨床中推廣使用.

引用本文： 李耀東,王一平,潘濤,田玲. 磷酸鈉法與聚乙二醇電解質液法在結腸鏡檢前腸道準備中應用效果的系統評價. 中國循證醫學雜志, 2005, 05(7): 555-561. doi: 復制

1.	歐陽欽,甘華田,陳立中.磷酸鈉口服清腸液結腸準備效果與安全性研究.中化消化內鏡雜志, 1998;15(5):278～280.
2.	Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion[J].Gastroenterology, 1980; 78(5 Pt 1):991-995.
3.	Vanner SJ, MacDonald PH, Paterson WG, Prentice RS, Da Costa LR, Beck IT. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy[J]. Am J Gastroenterol, 1990; 85(4):422-427.
4.	Clarke M, Oxman AD, editors. Cochrane Reviewers’Handbook 4.1[updated June 2000]. In: Review Manager (RevMan) [Computer program] [CD/M]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
5.	Cohen SM, Wexner SD, Binderow SR, Nogueras JJ, Daniel N, Ehrenpreis ED, Jensen J, Bonner GF, Ruderman WB. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods[J]. Dis Colon Rectum, 1994;37(7):689-696.
6.	David K, Chasen R, Choudhary C, Riff D, Steinberg S, Weiss E, Wruble L. Efficacy and safety of sodium phosphate tablets compared with PEG solution in colon cleansing: two identically designed, randomized, controlled, parallel group, multicenter phase III trials[J]. Gastrointest Endosc, 2001; 54(6):705-713.
7.	Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation[J]. Gastrointest Endosc, 1993; 39(5):631-634.
8.	Henderson JM, Barnett JL, Turgeon DK, Elta GH, Behler EM, Crause I, Nostrant TT. Single-day, divided-dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance[J]. Gastrointest Endosc, 1995; 42(3):238-243.
9.	Clarkston WK, Tsen TN, Dies DF, Schratz CL, Vaswani SK, Bjerregaard P. Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison[J]. Gastrointest Endosc, 1996; 43(1):42-48.
10.	Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda[J]. Gastrointest Endosc, 2000; 52(3):346-352.
11.	Chia YW, Cheng LC, Goh PM, Ngoi SS, Isaac J, Chan ST, Ti TK. Role of oral sodium phosphate and its effectiveness in large bowel preparation for out-patient colonoscopy[J]. J R Coll Surg Edinb, 1995; 40(6):374-376.
12.	Ell C, Fischbach W, Keller R, Dehe M, Mayer G, Schneider B, Albrecht U, Schuette W; Hintertux Study Group. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*)[J]. Endoscopy, 2003; 35(4):300-304.
13.	Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy[J]. Dis Colon Rectum, 1997; 40(1):100-104.
14.	Lapalus MG, Gaudin JL, Lemkecher T, Souquet JC, Wendehenne F, Peltrault C, Pontette F, Pillon M, Monier JM, Dumont O. Prospective randomized single-blind trial comparing oral sodium phosphate with polyethylene glycol for colonoscopy preparation[J]. Gastroenterol Clin Biol, 2001;25(1): 29-34.
15.	Lee J, McCallion K, Acheson AG, Irwin ST. A prospective randomised study comparing polyethylene glycol and sodium phosphate bowel cleansing solutions for colonoscopy[J]. Ulster Med J, 1999; 68(2):68-72.
16.	Martinek J, Hess J, Delarive J, Jornod P, Blum A, Pantoflickova D, Fischer M, Dorta G. Cisapride does not improve precolonoscopy bowel preparation with either sodium phosphate or polyethylene glycol electrolyte lavage[J]. Gastrointest Endosc, 2001; 54(2):180-185.
17.	Marshall JB, Barthel JS, King PD. Short report: prospective, randomized trial comparing a single dose sodium phosphate regimen with PEG-electrolyte lavage for colonoscopy preparation[J]. Aliment Pharmacol Ther, 1993; 7(6):679-682.
18.	Seinela L, Pehkonen E, Laasanen T, Ahvenainen J. Bowel preparation for colonoscopy in very old patients: a randomized prospective trial comparing oral sodium phosphate and polyethylene glycol electrolyte lavage solution[J]. Scand J Gastroenterol, 2003;38(2):216-220.
19.	Da Silva MM, Briars GL, Patrick MK, Cleghorn GJ, Shepherd RW. Colonoscopy preparation in children: safety, efficacy, and tolerance of high-versus low-volume cleansing methods[J]. J Pediatr Gastroenterol Nutr, 1997; 24(1):33-37.
20.	Thomson A, Naidoo P, Crotty B. Bowel preparation for colonoscopy: a randomized prospective trail comparing sodium phosphate and polyethylene glycol in a predominantly elderly population[J]. J Gastroenterol Hepatol, 1996; 11(2):103-107.
21.	Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution[J]. Gastrointest Endosc, 1996; 43(5):463-466.
22.	Ouyang Qin, Gan Huatian, Cheng Lizhong. The effective and tolerance of oral sodium phosphate for colonoscopic preparation[J]. Chinese Digestive Jounal, 1998; 15(5):278-280.

1. 歐陽欽,甘華田,陳立中.磷酸鈉口服清腸液結腸準備效果與安全性研究.中化消化內鏡雜志, 1998;15(5):278～280.
2. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion[J].Gastroenterology, 1980; 78(5 Pt 1):991-995.
3. Vanner SJ, MacDonald PH, Paterson WG, Prentice RS, Da Costa LR, Beck IT. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy[J]. Am J Gastroenterol, 1990; 85(4):422-427.
4. Clarke M, Oxman AD, editors. Cochrane Reviewers’Handbook 4.1[updated June 2000]. In: Review Manager (RevMan) [Computer program] [CD/M]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
5. Cohen SM, Wexner SD, Binderow SR, Nogueras JJ, Daniel N, Ehrenpreis ED, Jensen J, Bonner GF, Ruderman WB. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods[J]. Dis Colon Rectum, 1994;37(7):689-696.
6. David K, Chasen R, Choudhary C, Riff D, Steinberg S, Weiss E, Wruble L. Efficacy and safety of sodium phosphate tablets compared with PEG solution in colon cleansing: two identically designed, randomized, controlled, parallel group, multicenter phase III trials[J]. Gastrointest Endosc, 2001; 54(6):705-713.
7. Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation[J]. Gastrointest Endosc, 1993; 39(5):631-634.
8. Henderson JM, Barnett JL, Turgeon DK, Elta GH, Behler EM, Crause I, Nostrant TT. Single-day, divided-dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance[J]. Gastrointest Endosc, 1995; 42(3):238-243.
9. Clarkston WK, Tsen TN, Dies DF, Schratz CL, Vaswani SK, Bjerregaard P. Oral sodium phosphate versus sulfate-free polyethylene glycol electrolyte lavage solution in outpatient preparation for colonoscopy: a prospective comparison[J]. Gastrointest Endosc, 1996; 43(1):42-48.
10. Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda[J]. Gastrointest Endosc, 2000; 52(3):346-352.
11. Chia YW, Cheng LC, Goh PM, Ngoi SS, Isaac J, Chan ST, Ti TK. Role of oral sodium phosphate and its effectiveness in large bowel preparation for out-patient colonoscopy[J]. J R Coll Surg Edinb, 1995; 40(6):374-376.
12. Ell C, Fischbach W, Keller R, Dehe M, Mayer G, Schneider B, Albrecht U, Schuette W; Hintertux Study Group. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01*)[J]. Endoscopy, 2003; 35(4):300-304.
13. Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy[J]. Dis Colon Rectum, 1997; 40(1):100-104.
14. Lapalus MG, Gaudin JL, Lemkecher T, Souquet JC, Wendehenne F, Peltrault C, Pontette F, Pillon M, Monier JM, Dumont O. Prospective randomized single-blind trial comparing oral sodium phosphate with polyethylene glycol for colonoscopy preparation[J]. Gastroenterol Clin Biol, 2001;25(1): 29-34.
15. Lee J, McCallion K, Acheson AG, Irwin ST. A prospective randomised study comparing polyethylene glycol and sodium phosphate bowel cleansing solutions for colonoscopy[J]. Ulster Med J, 1999; 68(2):68-72.
16. Martinek J, Hess J, Delarive J, Jornod P, Blum A, Pantoflickova D, Fischer M, Dorta G. Cisapride does not improve precolonoscopy bowel preparation with either sodium phosphate or polyethylene glycol electrolyte lavage[J]. Gastrointest Endosc, 2001; 54(2):180-185.
17. Marshall JB, Barthel JS, King PD. Short report: prospective, randomized trial comparing a single dose sodium phosphate regimen with PEG-electrolyte lavage for colonoscopy preparation[J]. Aliment Pharmacol Ther, 1993; 7(6):679-682.
18. Seinela L, Pehkonen E, Laasanen T, Ahvenainen J. Bowel preparation for colonoscopy in very old patients: a randomized prospective trial comparing oral sodium phosphate and polyethylene glycol electrolyte lavage solution[J]. Scand J Gastroenterol, 2003;38(2):216-220.
19. Da Silva MM, Briars GL, Patrick MK, Cleghorn GJ, Shepherd RW. Colonoscopy preparation in children: safety, efficacy, and tolerance of high-versus low-volume cleansing methods[J]. J Pediatr Gastroenterol Nutr, 1997; 24(1):33-37.
20. Thomson A, Naidoo P, Crotty B. Bowel preparation for colonoscopy: a randomized prospective trail comparing sodium phosphate and polyethylene glycol in a predominantly elderly population[J]. J Gastroenterol Hepatol, 1996; 11(2):103-107.
21. Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution[J]. Gastrointest Endosc, 1996; 43(5):463-466.
22. Ouyang Qin, Gan Huatian, Cheng Lizhong. The effective and tolerance of oral sodium phosphate for colonoscopic preparation[J]. Chinese Digestive Jounal, 1998; 15(5):278-280.

《中國循證醫學雜志》

磷酸鈉法與聚乙二醇電解質液法在結腸鏡檢前腸道準備中應用效果的系統評價

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《中國循證醫學雜志》

磷酸鈉法與聚乙二醇電解質液法在結腸鏡檢前腸道準備中應用效果的系統評價

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