鼻肠管在Roux-en-Y吻合术后加速康复中的临床意义  

Clinical significance of nasointestinal tube placement in facilitating recovery after Roux-en-Y gastric bypasssurgery

作　　者：贾贵清[1] 刘鑫[2] 杨洲[1] 覃先蓬[1] 赵高平[1] 

机构地区：[1]四川省医学科学院四川省人民医院胃肠外科,成都610072 [2]四川省医学科学院四川省人民医院检验科,成都610072

出　　处：《中华临床营养杂志》2017年第6期350-354,共5页Chinese Journal of Clinical Nutrition

基　　金：四川省医学科学院四川省人民医院青年基金（2015QN11）

摘　　要：目的探讨鼻肠管肠内营养在Roux-en-Y吻合术后加速康复的临床意义。方法胃肿瘤Roux-en-Y吻合术后置入鼻肠管28例患者归为研究组，未置入鼻肠管33例患者归为对照组。分析两组患者营养状况[体质量指数（BMI）、营养风险筛查2002（NRS2002）评分、总蛋白（TP）、白蛋白（Alb）和前白蛋白]和预后指标（肠鸣音恢复及肛门排气或排便时间、吻合口漏、腹腔脓肿或感染、切口感染或延迟愈合、术后肺部感染、术后住院时间、非计划内再手术或再入院率）。结果两组基线资料（性别、年龄、BMI、NRS2002评分、手术时间及术中出血量）比较差异均无统计学意义（P均〉0．05）。两组术后第6天前白蛋白（t=-2．05，P=0．045）、肠鸣音恢复时间（t=7．71，P=0．000）、肛门排气或排便时间（t=4．52，P=0．000）、术后住院时间（t=4．43，P=0．000）、切口感染或延迟愈合率（χ^2=4．78，P=0．029）比较，差异均有统计学意义。两组吻合口漏、腹腔脓肿或感染率、非计划内再手术率或再人院率比较差异均无统计学意义（P均〉0．05）；术后肺部感染比较差异无统计学意义（P〉0．05），而≥70岁患者两组比较差异有统计学意义（Fisher法，P=0．029）。结论胃肿瘤Roux-en-Y吻合术经鼻肠管肠内营养可促进机体蛋白合成，促进肠功能恢复，缩短住院时间等，有利于患者术后加速康复，但建议I〉70岁者视患者肺部情况是否置管或提前拔管。Objective To investigate the clinical significance of nasointestinal tube placement in facili- tating recovery after Roux-en-Y gastric bypass surgery. Methods The clinical data of patients with gastric neo- plasms who underwent Roux-en-Y gastric bypass surgery were analyzed retrospectively. 28 patients who had na- sointestinal tube inserted were compared to 33 patients who didn＇t. Indicators for nutrition [ body mass index （ BMI）, Nutrition Risk Screening 2002 （ NRS 2002） score, serum total protein （ TP）, albumin （Alb） and prealbumin] and prognosis （bowel sound and anal exhaust or defecation time, anastomotie leakage rate, ab- dominal abscess or infection, incision infection or delayed healing, postoperative pulmonary infection rate, post- operative hospitalization time, unplanned reoperation or readmission rate） were analyzed. Results There was no statistically significant difference （all P〉0. 05） between the two groups at baseline （sex, age, BMI, NRS 2002 score, operation time and blood loss during operation ）. The two groups had no statistically significant difference （all P〉0. 05） in TP, Alb and prealbumin before the operation or at day 2 or day 6 after the opera- tion. There were significant difference between the two groups in partial indicators for nutrition and prognosis： prealbumin at sixth days after operation （t =-2.05, P= O. 045）, bowel sound （ t= 7. 71, P= 0. 000）, anal exhaust or defecation time （t = 4. 52, P = 0. 000）, postoperative hospitalization time （t = 4. 43. P = 0. 000）. in-cision infection or delayed healing rate （X2 = 4. 78, P = O. 029）. No statistically significant difference （ all P〉 0. 05） was found in anastomotic leakage rate, abdominal abscess or infection rate, postoperative puhnonary in- fection rate, and unplanned reoperation and readmission rate （X2 = 1.94, P = 0. 164）. There was significant difference （ Fisher, P = 0. 029） between patients aged 70 or above in the two groups in terms of postoperative pulmona

关 键 词：肠道营养 胃肿瘤 胃切除术 吻合术 外科 加速康复外科 

分 类 号：R459.3[医药卫生—治疗学] R735.2[医药卫生—临床医学]