Tvíblind framskyggn athugun á gagnsemi þarmahreinsunar á utanspítalasjúklingum fyrir skuggaefnisrannsókn á þvagvegum

Objective: The aim of this study was to examine whether or not a bowel preparation should be administered prior to intravenous urography (IVU) on outpatients at the Reykjavik Hospital. Material and methods: In a period of seven months 89 outpatients remitted to IVU were randomly divided into two groups, A and B. Patients in group A went through bowel preparation before the investigation but patients in group B did not. The patients in group B were asked to consume only fluids, beginning the evening before the investigation. Five patients were excluded from the study. The remaining 84 patients were equally divided between groups A and B. Before the investigation all patients in both groups were asked to fill out a questionnaire giving their reactions to the preparation procedure. Three experienced radiologists performed image interpretation. Delineation of the urinary system, diagnostic ability and quality of cleansing were judged. The study was prospective and double blinded. The same type of contrast media, the same dose and the same type of film were used each time. A comparison of results between the two groups was carried out. Results: The age distribution was the same for both groups. Most of the patients in group A (76%) experienced the cleansing procedure as uncomfortable and 12% as awful. In group B most of the patients felt the preparation was comfortable. No one in group B said that the preparation was uncomfortable. There was no difference between the groups according to delineation of the urinary system except for the urinary bladder, where the delineation was judged to be worse in group B. Air in the bowel was the main disturbing factor in group A, but both air and faeces in group B. The quality of cleansing was judged to be better in group A. There was no difference between the groups in terms of diagnostic ability. Conclusions: Bowel preparation on outpatients before IVU causes discomfort to the patients and does not improve the quality of the results.
Tilgangur: Markmið þessarar rannsóknar var athugun á gagnsemi þarmahreinsunar á utanspítalasjúklingum fyrir skuggaefnisrannsóknir af þvagvegum (intravenous urography) á myndgreiningardeild Sjúkrahúss Reykjavíkur. Efniviður og aðferðir: Á sjö mánaða tímabili var 89 sjúklingum, sem sendir voru í skuggaefnisrannsókn af þvagvegum, skipt tilviljanakennt í tvo hópa, A og B. Sjúklingar í hópi A fengu þarmahreinsun fyrir rannsóknina en þeir í hópi B enga. Sjúklingar í þessum hópi voru beðnir um að neyta aðeins fljótandi fæðis frá kvöldinu fyrir rannsóknina. Fimm sjúklingar féllu úr rannsókninni. Eftir stóðu 84 sjúklingar sem skiptust jafnt milli hópa A og B. Fyrir rannsóknina voru sjúklingarnir beðnir um að fylla út spurningablöð þar sem spurt var um óþægindi þeirra vegna undirbúningsins. Þrír reyndir sérfræðingar í geislagreiningu framkvæmdu úrlestur rannsóknanna. Metnar voru útlínur þvagvega og mat lagt á greiningarhæfni rannsóknarinnar og heildargæði. Rannsóknin var framskyggn og tvíblind. Sama tegund skuggaefnis, styrkur og magn var notað í hvert sinn. Sama filmutegund var ávallt notuð. Samanburður var gerður milli þessara tveggja hópa. Niðurstöður: Aldursdreifing var sú sama milli hópanna. Flestum sjúklinganna í hópi A (76%) fannst undirbúningurinn óþægilegur. Úr þessum hópi töldu 12% sjúklinga að undirbúningur ylli miklum óþægindum. Langflestum í hópi B fannst undirbúningurinn þægilegur en engum að hann ylli miklum óþægindum. Enginn munur var á milli hópanna þegar mat var lagt á útlínur þvagvega, nema á þvagblöðru sem sást verr í hópi B. Loft í görnum var aðal truflanavaldur í hópi Aen bæði loft og hægðir í hópi B. Gæði hreinsunar voru marktækt betri í hópi A. Enginn munur var milli hópanna á greiningarhæfni rannsóknanna. Lokaorð: Hreinsun þarma fyrir skuggaefnisrannsóknir á þvagvegum valda talsverðum óþægindum fyrir sjúklinga og bæta ekki gæði rannsóknanna.