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Подготовка к колоноскопии фортрансом и диета

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17 августа 2019

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Двухэтапная схема подготовки

Предлагаем вам ознакомиться с двухэтапной схемой подготовки к колоноскопии с использованием препарата Фортранс. Подготовка является более предпочтительной, так как обеспечивает лучшее качество подготовки и легче переносится пациентом.

Рекомендуется при проведении исследования в обед после 11:00 .

  1. За 3 дня до исследования соблюдайте бесшлаковую диету.
  2. За 1 день до исследования до 15:00 принимайте только жидкости и не употребляйте твердую пищу.

1 этап приема Фортранса (за 1 день до исследования):

  • 18:00-19:00 — примите 1 л Фортранса (по 1 стакану каждые 15 минут).
  • 19:00-20:00 — примите еще 1 л препарата (по 1 стакану каждые 15 минут).

2 этап приема Фортранса (в день исследования):

Если исследование проводится без обезболивания (седации), можно выпить чай с медом или негазированную воду. Если исследование проводится с использованием обезболивающих, необходимо быть натощак.

  • 5:30-6:30 — примите 1 л Фортранса (по 1 стакану каждые 15 минут).
  • 6:30-7:30 — примите 1 л Фортранса (по 1 стакану каждые 15 минут).

Одноэтапная схема подготовки

Рекомендуется при проведении исследования утром до 11:00 .

  1. За 3 и 2 дня до исследования соблюдайте бесшлаковую диету.
  2. За 1 день до исследования до 13:00 принимайте только жидкости и не употребляйте твердую пищу.

С 16:00 до 20:00 — принимайте по 1 л Фортранса (на протяжении 4-х часов по 1 стакану каждые 15 минут).

В день исследования при проведении процедуры без обезболивающих можно выпить чай с медом или воду без газа. При проведении процедуры под седацией (с обезболивающим), требуется избежать приема пищи и быть натощак.

Указанное время приема можно менять, но важно помнить, что прием последней дозы Фортранса рекомендуется закончить за 3-4 часа до начала исследования.

Бесшлаковая диета

МОЖНО принимать рафинированную пищу и легко перевариваемые продукты:

  • Отварное мясо (нежирные сорта), рыба, курица
  • Бульон
  • Обезжиренные кисломолочные продукты без фруктовых добавок
  • Вареные яйца
  • Омлет
  • Мед
  • Желе
  • Не крепкий чай или кофе, прозрачные соки без мякоти
  • Не газированную воду

НЕЛЬЗЯ употреблять пищу, богатую клетчаткой и плохо перевариваемыми продуктами:

  • Зерновые продукты, крупы
  • Фрукты, овощи, ягоды, зелень
  • Злаковые, бобовые, орехи
  • Жирные сорта мяса, рыбы, птицы, грибы
  • Крем-супы, копчености, консервы, колбасы
  • Жирные молочные продукты
  • Хлеб, сладости
  • Алкоголь и газированные напитки

Общие рекомендации по подготовке к колоноскопии

Колоноскопия (ФКС) является одним из самых информативных способов обследования толстого кишечника и дистального отдела тонкой кишки. Залогом успешной колоноскопии является очищенный кишечник. Кал и остатки пищи ухудшают обзор и затрудняют манипуляцию. Неправильная подготовка к этому обследованию может привести к невозможности полноценного осмотра кишки и необходимости повторного обследования после адекватной подготовки.

Для успешной реализации этой диагностической процедуры требуется особая подготовка к ФКС, предусматривающая полноценную очистку кишечника. Подготовка к плановой процедуре начинается за 3-5 дней.

Прежде, чем приступить к подготовке к колоноскопии, необходимо согласовать с лечащим врачом все принимаемые препараты. В отдельных случаях специалист может скорректировать схему приемов медикаментозных средств с учетом планируемой колоноскопии.

Диета перед колоноскопией

Что такое бесшлаковая диета

Бесшлаковая диета — это образ питания, который позволяет вывести из организма всевозможные нежелательные соединения. В повседневной жизни она обеспечивает своеобразную чистку тела и улучшает состояние здоровья. Бесшлаковая диета для подготовки к колоноскопии отличается от стандартного варианта этой диеты тем, что рассчитана на довольно непродолжительный срок — всего 3-5 дней. Это низкокалорийная диета, предусматривающая полное исключение их питания за трое суток до колоноскопии жирных рыбных и мясных продуктов, копченых изделий, бобовых, жирных кисломолочных продуктов, круп, зерновых продуктов.

Вместо свежих овощных и фруктовых продуктов следует употреблять отвары из овощей, напитки из фруктов и ягод. Из рациона надо изъять напитки с газом, красителями и спиртом, приправы с перцем и соусы. При этом важно полностью исключить ужин, а во второй половине дня разрешено потребление лишь воды, чая или кисломолочных напитков.

Меню на 3 дня перед процедурой

Чтобы кишечник был качественно подготовлен для колоноскопии? можно использовать следующую диету перед колоноскопией на 3 суток:

  • За 3 дня: Употребление овощей, приготовленных на пару и отварных. Завтрак в виде каши на воде. Обед из постного мяса и тушеных овощей, ужин из творога и кефира.
  • За 2 дня: Крекеры и чай на завтрак, небольшой кусок рыбы. На обед — тушеные овощи, на ужин — нежирный кефир и паровой омлет.
  • За 1 день: Отварные овощи и зеленый чай на завтрак, рисовый суп в обед, далее разрешены только зеленый чай, бульон и вода без газа.
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Последний прием пищи перед колоноскопией

За день до колоноскопии допустимо употребление прозрачного бульона, зеленого чая и воды без газа. В случае, когда колоноскопия назначена до обеда, потребление небольшого количества пищи приемлемо не позднее 15:00, если же обследование будет проводиться после обеда, небольшой перекус допустим до 17:00. Затем позволительно употребление лишь несладкого чая и простой воды.

В день проведения колоноскопии можно употреблять слабый чай или воду. Если же колоноскопия проводится с использованием внутривенного наркоза, то она должна проводиться исключительно натощак.

Что можно есть перед процедурой, а что нельзя

Перед процедурой нельзя есть твердую пищу, однако допустимо употреблять только негазированную питьевую воду.

При диабете

При сахарном диабете бесшлаковая диета перед проведением колоноскопического исследования может представлять определенные сложности для пациента, поэтому диабетику необходимо тщательно обсудить все особенности своего рациона с врачом. Больные диабетом регулярно принимают инсулиносодержащие и сахароснижающие препараты, о чем необходимо заранее сообщить врачу, проводящему колоноскопию.

Подготовка препаратами

Даже самая продуманная диета перед ФКС не позволяет достичь полного очищения кишечника от кала. Поэтому накануне исследования применяют специализированные препараты очищающего действия.

Пожалуйста, внимательно ознакомьтесь с инструкцией к выбранному препарату.

Препарат Мовипреп

Один из эффективных препаратов для подготовки к колоноскопии — Мовипреп. Для качественной подготовки необходимо выпить 4 пакета препарата, растворенного в простой воде (2 литра). Однако объем выпитой жидкости должен составлять не менее 3 литров: препарат дополняется простой водой, некрепким чаем, прозрачными не газированными безалкогольными напитками.

В зависимости от того, на какое время назначена колоноскопия, применяется одна из схем приема препарата:

  • Двухэтапная схема, если процедура проводится в первой половине дня до 14.00. С 20.00 до 21.00 накануне колоноскопии необходимо принять первый литр раствора препарата. В день колоноскопии утром с 6.00 до 7.00 принять второй литр раствора препарата. При необходимости время приёма препарата может корректироваться с соблюдением указанных временных интервалов. После каждого принятого литра препарата не забудьте выпить 500 мл разрешённой жидкости.
  • Одноэтапная утренняя схема, если процедура проводится во второй половине дня после 14:00. С 8 до 9 утра принять первый литр раствора препарата. С 10 до 11 утра принять второй литр раствора препарата. При необходимости время приёма препарата может корректироваться с соблюдением указанных временных интервалов. После каждого принятого раствора препарата не забудет выпить 500 мл разрешённой жидкости.

Важно: приём препарата необходимо прекратить не менее чем за 3-4 часа до начала процедуры. Раствор препарата принимать дробно по 250 мл каждые 15 минут. Приготовленный раствор хранить в холодильнике.

Препарат Фортранс

Часто используется подготовка к колоноскопии Фортрансом. Этот препарат представляет собой водорастворимый порошок, который при попадании в кишечник не поглощается и выводится из организма. Препарат принимается дома, перед употреблением его растворяют в кипяченой воде и полученный раствор принимается внутрь. Фортранс принимается накануне обследования, 2-3 часа после обеда. При этом каждые 15-20 минут на протяжении 3-4 часов человек выпивает по стакану раствора этого препарата. Всего необходимо выпить 4 литра слабительного раствора (4 пакета растворяется в 4 литрах воды).

Неэффективные и устаревшие методы подготовки

Клизма

Очистка кишечника с помощью клизмы достаточно давно является распространенным способом подготовки пациента к колоноскопии. Однако популярность этого метода в последние десятилетия неуклонно снижается, и все больше людей отдают предпочтение медикаментозному способу.

Согласно клиническим исследованиям, очищение клизмой позволяет эффективно подготовиться к ФКС только в 46% случаев. Также у подготовки к колоноскопии клизмой есть ряд существенных недостатков:

  • очищение только толстой кишки, в то время как для полноценной подготовки требуется очищение кишечника целиком
  • метод более трудоемкий, требует больше времени и помощи со стороны
  • клизменная очистка достаточно дискомфортна и травматична для слизистой кишечника.

Свечи

Для очищения кишечника перед колоноскопией среди прочих методов могут применяться ректальные свечи со слабительными препаратами, обладающим слабительным действием. Как основной способ подготовки свечи не применяются. Необходимость использования свечей как дополнительного средства следует обсудить с лечащим врачом, назначающим процедуру.

Касторовое масло

Клизменное очищение может сочетаться со слабительными препаратами для усиления эффекта. В частности, при склонности к запорам, касторовое масло можно использовать в качестве дополнительной подготовки наряду с основным слабительным препаратом.

Флит Фосфо-Сода

На протяжении нескольких лет данный препарат являлся одним из часто назначаемых, однако в середине 2017-го года он был снят с производства. Это решение было связано с некоторыми побочными эффектами применения, среди которых — повышенный уровень раздражения слизистой оболочки кишечника. По этой же причине подготовка препаратом Флит Фосфо-Сода не рекомендуется пациентам с воспалительными заболеваниями кишечника.

Другие препараты

Подготовка к процедуре колоноскопии лаваколом встречается достаточно часто. Также многие прибегают к подготовке к колоноскопии дюфалаком. Оба эти препарата подготавливают кишечник недостаточно и мы не рекомендуем их к использованию.

Подготовка к колоноскопии и ФГДС

Как при колоноскопии, так и при фиброгастродуоденоскопии обследуемый зачастую подвергается неприятным ощущениям, связанным с проведением процедуры. Поэтому практикуется одновременное выполнение этих двух процедур под наркозом, то есть во время однократной общей анестезии. Это позволяет повысить комфортность процедуры для пациента, избавиться от стресса и неприятных ощущений, связанных с проведением процедуры без наркоза.

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Подготовка к колоноскопии и ФГДС проводится в соответствии с положениями, перечисленными выше, то есть главное условие проведения процедур — быть натощак, и нет каких-либо дополнительных требований.

Подготовка к колоноскопии кишечника под наркозом

Подготовка к колоноскопии под наркозом проводится в соответствии с положениями, перечисленными выше. Кроме этого перед процедурой требуется сдать ряд анализов, чтобы убедиться в безопасности использования общего наркоза:

  • ЭКГ
  • сахар крови
  • клинический анализ крови
  • общий анализ мочи
  • заключение терапевта о возможности проведения наркоза
  • другие исследования в зависимости от требований лечащего врача и анестезиологов-реаниматологов. Например, могут понадобится анализы креатинин, АлАТ, АсАТ, протромбин, МНО.

Сдача этих анализов перед проведением колоноскопии под общим наркозом позволит обеспечить безопасность здоровья обследуемого и высокое качество подготовки к колоноскопии.

Результаты

После прохождения колоноскопии в гастро-гепатоцентре ЭКСПЕРТ вы получите развернутое заключение врача, в котором будет описано состояние толстого кишечника. На основании грамотно проведенного исследования лечащий врач установит диагноз и назначит правильное лечение.

С результатами вы всегда можете обратиться к нашим экспертам-гастроэнтерологам: на очную консультацию или онлайн по Skype.

Фортранс принадлежит к группе послабляющих средств, используемых в качестве экстренной и эффективной очистке кишечника от каловых масс, включая застойные отложения. В клинической практике Фортранс широко применяется перед инвазивными диагностическими манипуляциями, перед оперативным вмешательством. Целесообразность применения определяется исключительно врачом на основании данных клинического анамнеза пациента, его возраста, необходимости применения анестезии и других критериев.

Чистка кишечника перед колоноскопией Фортрансом — основные показания к назначению

Порошок Фортранс рекомендуется для очищения всех отделов кишечника от каловых масс при необходимости подготовки к операциям, различным диагностическим исследованиям: эндоскопические исследования, колоноскопия, ректороманоскопия.

Основными показаниями к назначению считают:

  1. Подготовка к хирургической операции при геморрое, полипах кишечника любой локализации (как быстро растут полипы в кишечнике читайте здесь);
  2. Манипулятивная диагностика: ректороскопия, колоноскопия;
  3. Экстренное очищение кишечника перед иными вмешательствами;
  4. Профилактические очищения кишечника после операции.

Многие пациенты применяют Фортранс при попытках похудеть, однако сохраняются риски обезвоживания организма. Очищение кишечника порошкообразным препаратом Фортранс за одну процедуру намного эффективнее многократного клизменного очищения.

Обратите внимание! После процедуры медикаментозного очищения врачи рекомендуют пропить курс пробиотиков, эубиотиков и лактобактерий для восстановления микрофлоры органов ЖКТ.

Аналоги и сравнительные характеристики

Учитывая некоторые противопоказания, особенные указания и вероятность развития побочных явлений, Фортранс подходит не всем категориям пациентов. В этом случае используют аналоги препаратов, различия которых заключаются не только в производителе, но и в дозировке основного компонента, степени схожести фармакологических свойств.

Известны несколько основных групп с послабляющим воздействием на мускулатуру кишечника:

  • На основе макрогола (Фортранс, Реалаксан, Эндофальк);
  • На основе лактулозы (Порталак, сироп Дюфалак);
  • На основе солевого компонента (Микролакс, Пикопреп, Мовипреп).

Другими аналогичными препаратами являются Транзипег, Осмоголь, Лавакол, в составе которых макрогол содержится в различных дозировках. Выбор в пользу аналогов может быть вызван и ценовым аспектом, что учитывается при назначении препарата перед проведением колоноскопии.

Фортранс – порошкообразное слабительное средство, эффективное и доступное для использования в домашних условиях.

Эндофальк и Фортранс

Сравнивая оба препарата, следует отметить их схожесть между собой активным компонентом, эффективностью воздействия. Основным лечебным компонентом выступает макрогол. Эндофальк содержит макрогола 3350 (полиэтиленгликоль) — 52 г, в составе Фортранс активного вещества немного больше — макрогол 4000 в объёме 64 г. Препараты отпускаются из аптечных сетей в виде порошка.

Оба препарата воздействуют только на желудочно-кишечный тракт, компоненты не всасываются в системный кровоток, никак не влияют на другие органы и ткани.

Внимание! Лекарственные средства для очистки кишечника недопустимо использовать при беременности и лактации, без назначения врача.

Мовипреп

В составе Мовипреп содержится макрогол 3350 в объёме 100 г, в Фортрансе — макрогола 4000. Во втором случае обеспечивается более длительный терапевтический эффект, особенно если процесс колоноскопии запланирован на вечернее время.

Использование Фортранса при длительном применении или превышении дозы нередко провоцирует у больных:

  • приступы тошноты;
  • раздражения слизистых;
  • кровоизлияния в сегменте сигмовидной кишки;
  • местные реакции в виде кожного зуда, покраснения.

При приёме Фортранса нужно выпить 4 л жидкости, а в случае с препаратом Мовипреп всего 2 л. Во втором случае решена проблема с неприятным вкусом при помощи подсластителя.

Если есть возможность выбирать между препаратами, то выбор следует отдать средству Мовипреп. Он легче переносится, его можно запивать сладким морсом, водой.

На заметку: Мовипреп идеально подходит при сниженном почечном клиренсе и скорости клубочковой фильтрации (признаки почечной недостаточности). Если же рвотный рефлекс развит слабо, отсутствует отягощённый клинический анамнез, то можно выбрать Фортранс.

Дюфалак

Если в основе Фортранса — синтетический компонент, то активным веществом препарата Дюфалак является лактулоза – вещество-субстрат для нормальной микрофлоры. В результате ферментации вещество распадается на органические кислоты, способствуют снижению кислотности в кишечнике и изменению, тем самым, осмотического давления. Перистальтика прямой кишки усиливается, размягчается стул и беспрепятственно выходит при опорожнении.

Во время приёма слабительных препаратов из организма вымывается жидкость, поэтому не рекомендуется их использование более 3-4 суток. Во время применения важно принимать достаточно много жидкости для восстановления водно-солевого баланса и исключения рисков обезвоживания.

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Многие пациенты ложно принимают выход жидкости из организма за похудение и пользуются этим методом в дальнейшим. Однако, на фоне приёма уходит только жидкость, а не лишние килограммы, приводя к серьёзным последствиям при бесконтрольном применении.

Как подготовиться Фортрансом в домашних условиях?

Основным преимуществом Фортранса является доступность и возможность очищения кишечника перед колоноскопией в домашних условиях.

Пациентам следует соблюдать следующие правила:

  • Не принимать препараты типа Лоперамид, Имодиум, Лопедиум, которые закрепляют стул;
  • Отказаться от применения клетчатки, которая задерживает воду в организме;
  • Нельзя голодать пациентам, имеющим в анамнезе сахарный диабет.

Накануне колоноскопии подготовка важна для достоверной оценки диагностического исследования, а также для исключения ошибок при наличии застарелых каловых масс в просветах кишечника.

Пациентам с запорами готовиться к процедуре следует за несколько суток.

Как пить препарат, если процедура утром?

Если колоноскопия назначена на утро, то пациентам необходимо следовать такой схеме:

  • Раствор Фортранса применяется в течение предшествующих суток;
  • Последний приём пищи должен быть не позднее 15.00 предшествующего дня;
  • Последнее опорожнение кишечника должно быть прозрачной водой.

После проведения колоноскопического исследования можно позавтракать или пообедать слизистой кашей или супом. Затем можно вернуться к привычному рациону.

Как готовиться, если колоноскопия в обед (в 12 часов дня и позже)?

Если процедура исследования просветов кишечника приходится днём на обеденное время, то инструкция по применению будет следующей:

  • Приём средства происходит в два этапа для усиления эффективности промывания кишечника;
  • Накануне следует начинать употребление напитка с порошком с 14 до 17 часов препарата малыми дозами;
  • Утром очищение следует повторить до появления абсолютно прозрачной воды без примеси каловых масс;
  • Перед обеденной процедурой важно повторить лечебное очищение не позднее 6 часов утра.

Это важно! Если пациент страдает сахарным диабетом, то допускается лёгкий завтрак и второй завтрак, чтобы инсулинзаместительная терапия полноценно заработала без ущерба для здоровья пациента.

Схема приёма во второй половине дня после 16 часов

Если процедура назначена на послеобеденное время, то накануне обследования необходимо принять полноценный обед не позднее 15.00. На утро перед обследованием завтракают лёгкой пищей, а в обед необходимо выпить кисель или несложный суп. В промежутке с 8.00 до 10.00 вечера нужно принять порцию (2 пакета, разведённые в 2 литрах воды) препарата.

Утром накануне операции или колоноскопического исследования необходимо принять ещё одну дозу препарата (2 пакетика-саше). Для усиления эффекта на протяжении нескольких дней перед колоноскопическим исследованием рекомендуется провести очистительные клизмы.

Если пациенты не имеют сахарного диабета, то при возможности, следует организовать разгрузочный день для полноценного очищения кишечника.

Как правильно принимать препарат перед колоноскопией с наркозом?

Наркоз при колоноскопии является определяющим фактором в соблюдении особой диеты и подготовки. Глубокая очистка кишечника Фортрансом начинается за двое суток до проведения процедуры. Накануне обследования последний приём пищи должен быть не позднее 16.00.

Процедура с наркозом должна быть проведена натощак во избежание негативных реакций:

На фоне приёма препарата следует соблюдать питьевой режим и потреблять около 2 л жидкости в сутки. Окончание очистительных процедур должно происходить до прозрачного водянистого стула.

При сахарном диабете наркоз можно заменить местным обезболиванием для сохранения возможности приёма пищи и инсулина.

Диета — можно ли есть перед процедурой после приёма препарата

Важным аспектом очистительной терапии кишечника является питание. Пациентам следует соблюдать диету, которая будет дополнительно способствовать очищению кишечника.

Идеально подойдут:

  • рыба, приготовленная на пару,
  • гречка или рис,
  • обезжиренный кефир,
  • кисели с минимальным содержанием сахара.

Из питья следует использовать чистую воду, избегая соков, насыщенных компотов или морсов.

На завтрак в предшествующие сутки лучше ограничиться:

  • слизистой безмолочной кашей,
  • обезжиренным йогуртом,
  • зелёным чаем с сухариком.

На протяжении дня можно съесть нежирный творог. Весь день накануне диагностики методом колоноскопии рекомендуют кушать нежирные бульоны, чай, кипячёную воду и сухарики.

Важно! Если процедура назначена на утро, обед или вечер, то здесь принцип питания идентичен. Следует прекратить любое питание не позднее 16.00 предшествующего дня.

Что можно пить кроме Фортранса?

Во время подготовки пациентам рекомендуется пить достаточно жидкости. Учитывая, что сам раствор готовят в 4 л воды и его необходимо выпить весь, то чистую воду пьют малыми глотками в промежутках между применением раствора. Питьё позволяет размягчать каловые массы, беспрепятственно выводить их из кишечника с очередными опорожнениями кишечника.

Как пить препарат, чтобы не тошнило?

Фортранс не отличается приятным вкусом, поэтому при высокой рвотной реакции пациента возможна сильная тошнота. Неприятные ощущения провоцируют сильную рвоту, а потому раствор может либо не подействовать, либо привести к сильному обезвоживанию. Для предупреждения обезвоживания можно пить воду небольшими глотками.

При нестерпимой тошноте подойдут противотошнотные таблетки, назначенные лечащим врачом. Поможет таблетка Мотилиума.

Эффективным является применение раствора Фортранса вприкуску с дольками апельсина, мандарина и других цитрусовых. Так можно немного улучшить вкусовые качества препарата и избавиться от негативных последствий.

Колоноскопия требует серьёзной подготовки. От дисциплинированности пациента в 70% зависит успешность и информативность всего исследования. Недопустимо применять препарат вопреки противопоказаниям, особенным указаниям при отягощённом клиническом анамнезе пациента.

Седация при колоноскопии, что это — читайте в нашей статье здесь.

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