肠内营养时机对消化道瘘急诊手术患者术后恢复的影响  

Effects of enteral nutrition at different time on recovery in patients with gastrointestinal fistula after emer⁃gency operation

作　　者：王晓通[1] 孔凡彪 李雷[1] 谢东毅 麦威[1] WANG Xiaotong;KONG Fanbiao;LI Lei;XIE Dongyi;MAI Wei(Departments of Gastrointes-tinal and Peripheral Vascular Surgery,People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院胃肠·疝·肠瘘外科,南宁530021 [2]广西壮族自治区人民医院普外小儿外科,南宁530021

出　　处：《实用医学杂志》2020年第20期2871-2875,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:81660416);广西卫健委自筹课题(编号:Z20180739);广西人民医院青年基金(编号:QN2018-22)。

摘　　要：目的探讨不同肠内营养时机对消化道瘘急诊手术患者术后恢复的影响。方法回顾性分析2008年1月1日至12月31日广西壮族自治区人民医院收治的62例消化道瘘急诊手术患者的临床资料。其中32例患者术后48 h内进行肠内营养设为观察组,30例患者胃肠功能恢复后进行肠内营养设为对照组。观察患者术后3、7、14 d的营养指标(白蛋白、前白蛋白、血红蛋白、转铁蛋白、体质量、三头肌皮皱厚度、尿中三甲基组氨酸),感染指标(白细胞、C反应蛋白、降钙素原),术后并发症情况(切口感染、出血、腹胀、肠梗阻、腹泻),术后肛门或造瘘口排气时间、一期瘘口愈合率、病死率、住院时间。结果观察组和对照组患者对比,在术后3、7、14 d的营养指标和感染指标差异无统计学意义(P>0.05)。术后并发症方面,两组患者在切口感染率和出血率比较差异无统计学意义(P>0.05),但观察组患者较对照组在术后更容易出现腹胀、腹泻、肠梗阻(P<0.05)。两组患者在一期瘘口愈合率、死亡例数上比较差异无统计学意义(P>0.05),但观察组肛门或造瘘口排气时间晚于对照组(P<0.05),住院时间较对照组更长(P<0.05)。结论消化道瘘急诊手术患者术后过早进行肠内营养容易出现腹胀、腹泻、肠梗阻等不良反应,延长住院时间。应当于胃肠功能恢复后进行,更利于术后患者的恢复。Objective To investigate the effect of enteral nutrition at different time points on the recovery of patients with gastrointestinal fistula after emergency operation.Methods We retrospectively reviewed the clinical data of patients undergoing emergency operation for gastrointestinal fistula in the People′s Hospital of Guangxi Zhuang Autonomous Region from January 1,2008 to December 31,2018.62 patients were divided into 2 groups,the observation group treated with enteral nutrition less than 48h after operation and the control group with enteral nutrition when gastrointestinal function recovered after operation,respectively.Nutrient indexes(albumin,pre⁃al⁃bumin,hemoglobin,transferrin,weight,triceps skinfold and urinary trimethylhistidine)and infection index(WBC,c⁃reactive protein and procaicltonin)were recorded on the 3rd,7th and 14th day after operation in the two groups.Postoperative complications were retrospectively analyzed in terms of incision infection,bleeding,ventosity,diarrhea and intestinal obstruction.The exsufflation time of anus or stoma,primary healing rate of gastrointestinal fistula,mortality and the hospital length of stay were also compared between these two groups.Results There were no significant differences in nutrient index and infection index at the 3rd,7th and 14th day after operation between the observation group and control group(P>0.05).In terms of postoperative complications,the morbidity of ventosity,diarrhea and intestinal obstruction in the observation group was significantly higher than in the control group(P<0.05),while it had no significant difference in the rate of incision infection and bleeding between the groups(P>0.05).Otherwise,the longer exsufflation time of anus or stoma and hospital length of stay were showed in the observation group(P<0.05),whereas there was not significant difference in primary healing rate of gastrointestinal fistula and mortality(P>0.05).Conclusion The patients with gastrointestinal fistula have more complications such as ventosity,diarrhea an

关 键 词：肠内营养 消化道瘘 急诊手术 

分 类 号：R639[医药卫生—外科学]