围手术期肠内营养支持策略对顽固性便秘并发继发性巨结肠患者术后预后的影响  

The influence between perioperative nutritional support and outcome of refractory constipation patients complicated with megacolon

作　　者：吴任鸿 李佳勇 吴光龙 

机构地区：[1]广东省高州市妇幼保健院普通外科,525200

出　　处：《中国医师进修杂志》2013年第32期11-14,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨围手术期肠内营养支持策略对顽固性便秘并发继发性巨结肠患者术后预后的影响.方法 选择73例顽固性便秘并发继发性巨结肠行外科手术患者,均经胃肠减压和全静脉营养支持治疗,其中37例无法恢复肠道通畅,未接受肠内营养支持治疗而直接手术者作为对照组;36例恢复肠道通畅,行2周的全肠内营养支持后择期手术者作为观察组.比较两组营养学指标,手术情况及术后并发症发生情况.结果 两组手术时间及术中出血量比较差异无统计学意义（P＞0.05）.两组采用术式比较差异有统计学意义（P＜0.05）.观察组吻合口出血、吻合口瘘、肺炎发生率明显低于对照组[2.8％（1/36）比21.6％（8/37）、0比13.5％（5/37）、0比13.5％（5/37）],差异有统计学意义（P＜0.05）.两组住院时间,切口感染、尿潴留、肠梗阻发生率比较差异无统计学意义（P＞0.05）.观察组术后住院时间明显短于对照组[（12±3）d比（25±6）d],差异有统计学意义（P＜0.05）.两组入院时各指标比较差异无统计学意义（P＞0.05）.观察组术前去脂体重、脂肪量及血清白蛋白、转铁蛋白、前白蛋白均高于对照组[（41.9±7.6） kg比（38.7±3.0）kg、（13.2±4.0） kg比（7.8±2.7） kg、（37.9±2.6） g/L比（31.3 ±2.5） g/L、（2.9±0.6） μg/L比（2.0±0.6） μg/L、（243.7±25.2） mg/L比（141.2±11.9） mg/L],差异有统计学意义（P＜0.05）.观察组术后1个月体重、去脂体重、蛋白质含量、细胞内液、细胞外液、体质指数、白蛋白、转铁蛋白均优于对照组[（55.1±6.4） kg比（50.9±4.7） kg/（42.9±3.2） kg比（39.1±1.3） kg、（12.2±1.4）kg比（9.7±3.2） kg、（23.7±5.0）L比（18.8±5.5）L、（10.9±4.5）L比（7.7±0.8）L、（22.3±1.9） kg/m2比（17.5±3.6） kg/m2、（41.9±4.7） g/L比（33.1±2.9） g/L、（3.5±0.7） μg/L比（2.7±0.5）μg/L],差异有统计学意义（P＜0.05�Objective To explore the influence between perioperative nutritional support and outcome of refractory constipation patients complicated with megacolon.Methods Seventy-three patients with refractory constipation complicated with megacolon receiving surgical interventions were enrolled,both by gastrointestinal decompression and total parenteral nutrition support treatment.Thirty-seven cases who could not recover intestinal tract unobstructed,did not receive enteral nutrition support treatment and surgery as control group; 36 cases of patients with intestinal recovery unobstructed,after 2 weeks of total enteral nutrition support undergoing elective surgery as observation group.The nutrition indicators,surgery and postoperative complications between two groups were compared.Results The operation time and intraoperative blood loss compared between two groups had no significant difference （P 〉0.05）.The operation method between two groups was statistically significants （P 〈 0.05）.The incidence of anastomotic bleeding,anastomotic fistula and pneumonia in observation group were lower than those in control group [2.8% （1/36） vs.21.6% （8/37）,0 vs.13.5% （5/37） and 0 vs.13.5% （5/37）],there were significant differences （P 〈 0.05）.The hospitalization time,incidence of incision infection,urinary retention,intestinal obstruction between two groups had no significant difference （P 〉 0.05）.The postoperative hospital stay in observation group was shorter than that in control group [（12 ± 3） d vs.（25 ± 6） d],there was significant difference （P 〈 0.05）.The index comparison on admission similar between two groups had no statistical significance （P 〉0.05）.The preoperative fat weight,fat mass and serum albumin,transferrin and prealbumin in observation group were higher than those in control group [（41.9 ± 7.6） kg vs.（38.7 ± 3.0） kg,（13.2 ± 4.0） kg vs.（7.8 ± 2.7） kg,（37.9 ± 2.6） g/L vs.（31.3 ± 2.5） g/L,（2.9 ± 0.6） μ g/L vs.（2.0 ± 0.6） �

关 键 词：便秘 结肠切除术 肠道营养 

分 类 号：R459.3[医药卫生—治疗学] R656.9[医药卫生—临床医学]