目的

比较中老年人群应用聚乙二醇和磷酸钠盐的肠道清洁效果和结肠镜检查前临床评估的肠道准备质量与内镜下肠道清洁度的一致性，探索结肠镜检查前临床精准判断肠道清洁度的方法。

方法

将复旦大学附属华东医院收治的146 例预行结肠镜检查的50 ～75 岁患者分为聚乙二醇组（69 例）和磷酸钠盐组（77 例）进行肠道准备，比较两组患者服用肠道清洁剂后结肠镜检查前的末次粪便性状、内镜下肠道清洁度、肠道清洁剂耐受度、安全性；采用Kappa 检验法对肠道清洁度临床评估结果与内镜下波士顿评分结果进行一致性评价。

结果

无论是依据末次粪便性状判断，还是内镜下波士顿肠道准备评分量表评估，两组患者肠道清洁度的差异均无统计学意义（P ＞0.05）。仅以服用肠道清洁剂后的末次粪便性状作为肠道质量临床判断标准，其与结肠镜下肠道真实清洁度一致性较差，聚乙二醇组与磷酸钠盐组Kappa 值分别为0.348 和0.224（P ＜0.05或0.01）；而联合末次粪便性状和总排便次数进行判断，可提高临床预判与肠镜下肠道真实清洁度的一致性，聚乙二醇组与磷酸钠盐组Kappa 值分别为0.494 和0.644（P ＜0.01）。两组患者对肠道清洁剂的接受度和不良反应发生率的差异均无统计学意义（P ＞0.05），且两组患者用药前后肝肾功能及电解质水平无明显变化（P ＞0.05）。

结论

中老年人使用两种肠道清洁剂行肠镜前肠道准备的总体效果均良好，肠道清洁合格率高，联合肠道清洁剂服用后的总排便次数及末次粪便性状可以在肠镜检查前更精准地预判肠道清洁度。

Objective

To compare the bowel cleansing effects of polyethylene glycol and sodium phosphate as bowel preparations in middle-aged and elderly populations， evaluate the consistency between clinical assessment of bowel preparation quality and endoscopic bowel cleanliness，and explore methods for clinically predicting bowel cleanliness before colonoscopy.

Methods

A total of 146 patients aged 50-75 years， scheduled for colonoscopy in Huadong Hospital Affiliated to Fudan University， were randomly divided into two groups： the polyethylene glycol group （69 patients） and the sodium phosphate group （77 patients） for bowel preparation.The study compared the following between the two groups： the characteristics of the last stool before colonoscopy， the endoscopic bowel cleanliness， the tolerability of the bowel cleansing agents， and their safety.The Kappa test was used to assess the consistency between clinical evaluations of bowel cleanliness and the endoscopic Boston Bowel Preparation Scale （BBPS） scores.

Results

Regardless of whether bowel cleanliness was assessed based on the characteristics of the last stool or the endoscopic BBPS scores， no statistically significant difference was observed between the polyethylene glycol group and the sodium phosphate group in terms of bowel cleanliness （P ＞ 0.05）.Using the characteristics of the last stool after bowel cleansing as a single clinical indicator of bowel quality showed poor consistency with the true bowel cleanliness assessed by colonoscopy.The Kappa values for the polyethylene glycol group and the sodium phosphate group were 0.348 and 0.224， respectively （P ＜ 0.05 or P ＜ 0.01）.However， combining the last stool characteristics with the total number of bowel movements as clinical indicators for pre-assessing bowel cleanliness improved the consistency with true bowel cleanliness as evaluated by colonoscopy.The Kappa values for the polyethylene glycol and sodium phosphate groups increased to 0.494 and 0.644， respectively （P ＜ 0.01）.Regarding tolerability， 49.30% of patients in the polyethylene glycol group were willing to use polyethylene glycol again for bowel cleansing，while 57.10% of patients in the sodium phosphate group accepted sodium phosphate for bowel cleansing.The difference was not statistically significant （P ＞ 0.05）.The incidence of adverse events was not significantly different between the two groups （P ＞ 0.05）， and no significant changes were observed in liver and kidney function or electrolyte levels before and after treatment in either group（P ＞ 0.05）.

Conclusion

The overall bowel preparation effect before colonoscopy was good for both bowel cleansing agents in middle-aged and elderly patients， with a high bowel cleanliness rate.Combining the total number of bowel movements and the characteristics of the last stool after the use of bowel cleansing agents can more accurately predict bowel cleanliness before colonoscopy.