| Abstract | Kolonoskopija je metoda izbora za dijagnostiku i terapiju sluzničkih lezija debelog crijeva. Adekvatna priprema crijeva danas je prepoznata kao pokazatelj kvalitete kolonoskopije. Naime, uspješnost čišćenja crijeva utječe na dijagnostičku osjetljivost kolonoskopije u detekciji lezija debelog crijeva i ključna je za učinkovitost pretrage.
Cilj ovog rada bio je istražiti antropološke, socijalne i kliničke varijable koje djeluju na adekvatnu pripremu ispitanika za postupak kolonoskopije. Primijenjena je metoda ankete u ispitanika kod kojih je napravljena kolonoskopija tijekom razdoblja ispitivanja (ožujak - lipanj 2014.). Očišćenost crijeva bila je vrednovana Bostonskom ljestvicom za pripremu crijeva (engl. Boston bowel preparation scale, BBPS) koja je bila dio anketnog upitnika, pri čemu su vrijednosti iznad 7 uzete kao kriterij uspješne pripreme za kolonoskopiju. U ispitivanje je bilo uključeno 286 ispitanika. Medijan (interkvartilni raspon) dobi sudionika iznosio je 61 (50 - 71) godinu. Ukupno je bilo 176 ispitanika muškog spola (61,5 %) i 110 žena (38,5 %). Medijan (interkvartilni raspon) rezultata BBPS iznosio je 6 (4 - 8). Od ukupnog broja ispitanika njih 36 (12,5 %) nisu bili adekvatno pripremljeni (BBPS: 0 - 3), 105 (36,7%) ispitanika imalo je srednju vrijednost BBPS-a (4 - 6), dok je nešto više od polovine ispitanika 145 (50,7 %) imalo adekvatno pripremljena crijeva za pregled. Univarijatna analiza pokazala je da su s lošijom pripremom bolesnika povezani nizak stupanj obrazovanja ispitanika (OR = 0,48; 95 % CI: 0,24 - 0,97; p = 0,040), ASA status ispitanika (OR = 0,29; 95 % CI: 0,15 - 0,59; p = 0,001), korištenje režima bez polietilen-glikola, (χ2 = 45,72; df = 2; p < 0,001; η2 = 0,17), te vremenski odmak od uzimanja zadnje doze laksativa do početka pretrage veći od 4 sata (Mann-Whitney U = 3928,0; Bonferroni korigirani p < 0,001; AUC = 0,30). Multivarijatna analiza potvrdila je ASA status, nekorištenje PEG-a u režimu pripreme te vremenski odmak od zadnje doze kao bitne pretkazatelje loše pripreme crijeva. U provedenom su ispitivanju prepoznate varijable dostupne sestrinskoj ocjeni koje upućuju na lošu pripremu crijeva za kolonoskopski pregled. Korištenje ovog modela pomoći će u planiranju pripreme pacijenta za kvalitetnu kolonoskopiju. |
| Abstract (english) | Colonoscopy is the method of choice for diagnostics and therapy of mucous lesions of the colon. Adequate bowel preparation has today been recognized as an indicator of the quality of colonoscopy. In fact, successful bowel cleansing affects diagnostic sensitivity of colonoscopy in detecting lesions of the colon and is crucial for the efficacy of the procedure. The aim of the study was to investigate anthropological, social and clinical variables that affect adequate preparation of patients for colonoscopic procedure. A method of survey questionnaire was applied with subjects who underwent colonoscopy during the period of observation (March - June 2014). Bowel cleanness was evaluated using the Boston Bowel Preparation Scale (BBPS) that was part of the survey questionnaire, and values above 7 were taken as a criterion for successful colonoscopy. The study involved 286 subjects. Median (interquartile range) of subjects' age was 61 (50 - 71) years. There was a total of 176 male (61.5%) and 110 (38.5%) female subjects. Median (interquartile range) of BBPS results was 6 (4 - 8). Of the total number of subjects, 36 (12.5%) did not perform adequate preparation, i.e. their preparation score was in the 0 - 3 range, 105 (36.7%) subjects had medium preparation score values (4 - 6), while slightly more than half of the subjects (145; 50.7%) had the bowels adequately prepared for examination. Univariate analysis showed that subjects' low education level (OR = 0.48; 95% CI: 0.24-0.97; p = 0.040), ASA status (OR = 0.29; 95% CI: 0.15 - 0.59; p = 0.001), use of the regime without polyethylene glycol (χ2 = 45.72; df = 2; p < 0.001; η2 = 0.17), and > 4 hour delay from taking last laxative dose till the beginning of examination (Mann-Whitney U = 3928.0; Bonferroni corrected p < 0.001; AUC = 0.30) were associated with poor bowel preparation for colonoscopy. Multivariate analysis confirmed ASA status, nonuse of PEG in the preparation regime, and delay after last laxative dose as significant predictors of poor bowel preparation. Variables that are accessible for nurses' assessment and that indicate poor bowel preparation for colonoscopic examination have been recognized in the study. Application of this model will aid in planning patient's preparation for quality colonoscopic procedure. |
