术前留置胃管对婴幼儿心内直视术后胃肠道并发症的防治意义  

Effect of indwelling stomach tube on prevention and treatment of gastrointestinal complications after open heart surgery in infants

作　　者：卢荣梅[1] 王奇[1] 石海燕[1] 马浩[1] 薛炎[1] 邱立成[1] 王立新[1] 

机构地区：[1]武警总医院心血管外科,北京100039

出　　处：《武警医学》2009年第11期983-985,共3页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨术前留置胃管是否有利于婴幼儿心内直视术后胃肠道并发症的防治。方法342例体外循环(Cordiopulmonary bycass,CPB)心内直视术的先心病患儿,随机分为A组(术前留置胃管组177例)和B组(非术前留置胃管组165例),患儿均常规给予奥美拉唑抑制胃酸分泌。留置胃管后即刻及每间隔6 h进行胃液镜检和潜血试验至拔除气管插管正常进食为止,同时观察两组患儿胃肠道并发症如腹胀、恶心、呕吐、胃肠黏膜损伤和大出血的发生率。术后重度低心排、肾功能衰竭、呼吸辅助时间≥72 h的患儿除外。结果纳入统计学处理的患儿317例,A组(162例),B组(155例)。A组16例患儿术后出现腹胀、恶心、呕吐,发生率为9.8%;B组118例患儿术后出现上述症状,发生率为75.8%。组间差别有统计学意义(x^2=142.48,P<0.001)。A组发现胃肠黏膜损伤29例,胃肠道大出血3例;B组术后因胃肠道并发症留置胃管95例,发现胃肠黏膜损伤28例,胃肠道大出血7例。结论术前留置胃管可降低心内直视术后腹胀、恶心、呕吐的发生率,及时发现胃肠黏膜损伤和消化道大出血,有利于胃肠道并发症的防治。因此,婴幼儿心内直视术前应常规留置胃管。Objective To study whether indwelling stomach tube pre - operation helps in preventing and treating gastrointestinail complications after open heart surgery in infants. Methods Three hundred and forty - two infants with congenital heart diseases scheduled to undergo open heart surgery with cardiopulmonary bypass （CPB） were randomized into group A （pre -operation indwelling stomach tube group, 177cases） and group B （no pre - operation indwelling stomach tube group, 165cases）. Omeprazole was given routinely in two groups to restrain gastric acid secretion. Gastric juice test under microscope and occult blood test were made from indwelling stomach tube instantly to normal food intake after tracheal extubation at intervals of 6 hours. The incidences of gastrointestinal complications, such as abdominal distention, nausea, vomiting, gastrointestinal mucosa injury and hemorrhage were observed at the same time. Patients with severe low cardiac output, renal failure and mechanical ventilation time over 72 hours after operation were excluded. Results Three hundred and seventeen infants were included in statistical analysis （group A 162 cases and group B 155cases）. Sixteen cases developed abdominal distention, nausea and vomiting in group A post- operation, with an incidence of 9.8%. In group B, 118 cases developed above symptoms post -operation, with an incidence of 75.8% ; there was statistically significant difference between the two gmups（χ^2 = 142.48 ,P 〈0. 01 ）. In group A 29 cases had gastrointestinal mucosa injury and 7 cases had hemorrhage post - operation. In group B 95 cases had indwelled stomach tube post - operation for gastrointestinal complication, 28 cases had gastrointestinal mucosa injury and 7 cases had hemorrhage. Conclusions Pre - operative indwelling stomach tube decreases the incidences of abdominal distention, nausea and vomiting, helps in discovering gastrointestinal mucosa injury and hemorrhage promptly, thereby preventing and treating gastrointestinal complications. Therefor

关 键 词：留置胃管 体外循环 心脏手术 胃肠道并发症 

分 类 号：R654.2[医药卫生—外科学]