Abstract: Background　With the development of endoscopic diagnosis and treatment technology, colonoscopy has become the gold standard for colon cancer screening. Whether a patient's bowel preparation is adequate is closely related to the success of colonoscopy diagnosis and treatment.At present, there are few domestic and foreign studies on the status, cleanliness level and influencing factors of inpatients' bowel preparation.However, relevant studies have shown that the quality of bowel preparation of inpatients is worse than that of outpatients. Therefore, how to improve the quality of bowel preparation of inpatients remains to be studied, which has received extensive attention from scholars at home and abroad. Objective　To understand the difference in bowel preparation between inpatients and outpatients undergoing colonoscopy, and to analyze the influencing factors of bowel preparation of inpatients. Methods　From January to April 2018, a total of 447 inpatients and outpatients underwent colonoscopy in the Department of Gastroenterology, the Second Hospital of Hebei Medical University were selected by convenience sampling, with the outpatient group of 227 subjects and inpatient group of 220 subjects. Baseline data questionnaire and Activities of Daily Living（ADL） scale were used to understand the general situation of patients. The influencing factors of bowel preparation were studied by using the feedback table of influencing factors of bowel preparation, the bowel preparation quality scored by Ottawa Bowel Preparation Scale（OBPS）, and multiple linear regression was used to analyze the influencing factors of OBPS score in inpatients. Results　The rate of inadequate bowel preparation in the outpatient group was 23.3%（53/227） and in the inpatient group was 49.5%（109/220）. OBPS scores of right colon, transverse colon, left colon, fluid volume and OBPS total score in outpatient group were lower than those in inpatient group（P<0.05）．Nine factors，including the low fiber diet time before two days of colonoscopy, the movement steps from taking compound polyethylene glycol electrolyte powder（PEG） to discharging watery stools, the frequency of bowel activity after taking the PEG, the first bowel activity after taking the PEG, the time interval between bowel preparation and colonoscopy, time for discharging residue after taking PEG, the sleep before the colonoscopy, the temperature of water and the exercise two days before colonoscopy, were significantly different between the two groups（P<0.05）; multivariate linear regression analysis showed that the movement steps from taking PEG to discharging watery stools（β=0，P<0.001）, the frequency of bowel activity after taking the PEG〔β=-0.042，95%CI（-0.078，-0.007），P=0.019〕, time for discharging residue after taking PEG〔β=0.136，95%CI（0.033，0.238），P=0.010〕, the exercise two days before colonoscopy〔β=0.302，95%CI（0.100，0.504），P=0.004〕were influencing factors in OBPS scores of the right colon in inpatients. The steps from taking PEG to discharging watery stools（β=0，P<0.001）was the factor influencing OBPS scores of transverse colon , left colon in inpatients.The steps from taking PEG to discharging watery stools（β=0，P<0.001）, the time interval between bowel preparation and colonoscopy〔β=-0.050，95%CI（-0.090，-0.009），P=0.017〕, time for discharging residue after taking PEG〔β=0.155，95%CI（0.045，0.264），P=0.006〕were the influencing factors in OBPS scores of fluid volume in inpatients.The steps from taking PEG to discharging watery stools（β=0，P<0.001）, the frequency of bowel activity after taking the PEG〔β=-0.105，95%CI（-0.193，-0.017），P=0.020〕, time for discharging residue after taking PEG〔β=0.481，95%CI（0.226，0.736），P<0.001〕and the exercise two days before colonoscopy〔β=0.681，95%CI（0.178，1.184），P=0.008〕were the influencing factors of OBPS total score in inpatients. Conclusion　The movement steps from taking PEG to discharging watery stools, the frequency of bowel activity after taking the PEG, the time interval between bowel preparation and colonoscopy, time to discharge residue after taking PEG and the exercise two days before colonoscopy were the influencing factors of bowel preparation in inpatients. Medical workers should take corresponding measures according to the influencing factors to reduce the impact of inadequate bowel preparation and ensure a smooth progress of colonoscopy diagnosis and treatment.

Key words: Endoscopy, gastrointestinal；Inpatients；Bowel preparation；Polyethylene glycols；Root cause analysis

摘要： 背景　随着内镜诊疗技术的发展，结肠镜已成为结肠癌筛查的金标准，患者的肠道准备是否充分与结肠镜诊治是否成功密切相关。目前国内外对住院患者的肠道清洁现状、清洁水平及其影响因素等方面的研究较少，而相关研究表明住院患者相比门诊患者肠道准备质量差，因此如何提高住院患者肠道准备质量尚待研究，且受到国内外学者的广泛关注。目的　了解住院与门诊患者结肠镜诊治的肠道准备差异，并分析住院患者结肠镜诊治肠道准备的影响因素。方法　2018年1—4月采用便利抽样法选取河北医科大学第二医院消化内镜中心拟行结肠镜诊治的住院患者220例（住院组）与门诊患者227例（门诊组）为研究对象。采用基线资料调查表及日常生活活动能力（ADL）量表了解患者的一般情况，采用肠道准备影响因素反馈表了解患者肠道准备的影响因素，采用渥太华肠道准备评分量表（OBPS）对两组患者肠道准备质量进行评分，采用多元线性回归分析住院患者OBPS评分的影响因素。结果　门诊组肠道准备不充分率为23.3%（53/227），住院组肠道准备不充分率为49.5%（109/220），门诊组右半结肠、横结肠、左半结肠、全结肠液体量OBPS评分及OBPS总分低于住院组（P<0.05）。两组间诊治前2 d进食低纤维饮食时间、开始服用复方聚乙二醇电解质散（PEG）至排出水样便运动步数、服用PEG后排便总次数、服用PEG后首次排便时间、末次服用PEG至诊治时间间隔、服用PEG后出现残渣样便次数、诊治前一晚睡眠时间、服用PEG时水温、诊治前2 d运动量比较，差异均有统计学意义（P<0.05）。多元线性回归分析结果显示，开始服用PEG至排出水样便运动步数（β=0，P<0.001）、服用PEG后排便总次数〔β=-0.042，95%CI（-0.078，-0.007），P=0.019〕、服用PEG后出现残渣样便次数〔β=0.136，95%CI（0.033，0.238），P=0.010〕、诊治前2 d运动量〔β=0.302，95%CI（0.100，0.504），P=0.004〕是住院患者右半结肠OBPS评分的影响因素；开始服用PEG至排出水样便运动步数〔β=0，P<0.001〕是住院患者横结肠、左半结肠OBPS评分的影响因素；开始服用PEG至排出水样便运动步数〔β=0，P<0.001〕、末次服用PEG至诊治时间间隔〔β=-0.050，95%CI（-0.090，-0.009），P=0.017〕、服用PEG后出现残渣样便次数〔β=0.155，95%CI（0.045，0.264），P=0.006〕是住院患者全结肠液体量OBPS评分的影响因素；开始服用PEG至排出水样便运动步数（β=0，P<0.001）、服用PEG后排便总次数〔β=-0.105，95%CI（-0.193，-0.017），P=0.020〕、服用PEG后出现残渣样便次数〔β=0.481，95%CI（0.226，0.736），P<0.001〕、诊治前2 d运动量〔β=0.681，95%CI（0.178，1.184），P=0.008〕是住院患者OBPS总分的影响因素。结论　开始服用PEG至排出水样便运动步数、服用PEG后排便总次数、末次服用PEG至诊治时间间隔、服用PEG后出现残渣样便次数、诊治前2 d运动量是住院患者肠道准备质量的影响因素，医务工作者应根据其影响因素采取相应的措施，减少肠道准备不充分的影响，保证结肠镜诊治过程的顺利进行。

关键词: 内窥镜检查, 胃肠道；住院病人；肠道准备；聚乙烯二醇类；影响因素分析