小肠双造口和肠液回输在重度腹腔感染患者的应用  

Application of small intestine double stoma and succus entericus reinfusion in the patients with severe intra-abdominal infection

作　　者：朱晋国[1] 王健[1] 和源[1] 庄海文[1] 杨金云[1] 

机构地区：[1]江苏省淮安市第二人民医院胃肠外科,223300

出　　处：《中华胃肠外科杂志》2015年第7期667-670,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨小肠双造口和肠液回输在重度腹腔感染患者中的临床应用。方法将2005年2月至2014年11月间淮安市第二人民医院收治的10例高位小肠穿孔致重度腹腔感染的患者纳入研究。所选病例均为急诊手术，行小肠部分切除加小肠远近端肠管双造口术。术后待肠道功能基本恢复、腹腔感染得到基本控制后，经鼻胃管实施肠内营养，将近端造口引出的肠液回输入远端肠襻。分别测定肠液回输前后机体对营养物质糖、脂肪及氮的平均吸收系数，并检测血清蛋白水平。结果肠液回输后，患者对糖、脂肪及氮的平均吸收系数均显著增加[糖：（90．9±7．8）％比（82．7±15．2）％，P〈0．05；脂肪：（87．6±6．4）％比（59．1±10．8）％，P〈0．01；氮：（82．4±9．8）％比（67．2±15．4）％，P〈0．01]；血清中纤维连接蛋白[（285．6±3．6）mg／L比（157．0±22．6）mg／L，P〈0．01]、转铁蛋白[（4．86±0．21）g／L比（3.60±25）g／L，P〈0．05]和前白蛋白[（291．3±112．5）mg／L比（199．1±53．3）mg／L，P〈0．05]水平亦高于肠液回输前。结论小肠双造口和肠液回输能明显改善重度腹腔感染患者对三大营养物质的吸收．从而避免了短肠综合征的发生。Objective To evaluate the application of small intestine double stoma and succus entericus reinfusion in the patients with severe intra-abdominal infection. Methods Ten patients with high intestinal perforation from February 2005 to November 2014 were enrolled in the study. All the cases received emergency operation. Small bowel with intestinal perforation was resected, and double stoma was applied in the proximal and distal small intestine. When abdominal infection under control, total enteral nutrition was successfully administered from nasogastric tube. The succus entericus from the proximal intestine was collected and transfused back to the distal intestine. Stool was collected and fecal nitrogen, fat and carbohydrate contents were determined. Related serum protein levels were measured. Results As compared to pre-reinfusion, the absorption rate of carbohydrate [ （90.9±7.8） % vs. （82.7±15.2）%], fat [（87.6±6.4）% vs. （59.1±10.8）%], and nitrogen [（82.4±9.8）% vs. （67.2±15.4）%] increased after succus entericus reinfusion （P〈0.05）. The serum protein levels increased significantly as well[fibronectin： （285.6±3.6） vs. （157.0±22.6） mg/L, P〈0.01; transferrin： （4.86±0.21） vs. （3.60± 0.25） g/L,P〈0.05; pre-albumin：（291.3±112.5） vs. （199.1±53.3） mg/L, P〈0.05]. Conclusion Small intestine double stoma and succus entericus reinfusion are effective in improving the absorption of carbohydrate, fat and nitrogen in the patients with severe intra-abdominal infection.

关 键 词：小肠穿孔 腹腔感染 小肠双造口 肠液回输 

分 类 号：R656[医药卫生—外科学]