不同肠内营养给予途径对小肠瘘切除术后胃肠道功能恢复的影响  

Effects of different enteral nutrition feeding routes on postoperative gastrointestinal function recovery after definitive surgery for small intestinal fistula

作　　者：陈敏 李静 欧阳慧 孟英华 马云丽 CHEN Min;LI Jing;OUYANG Hui;MA Yun-li(Research Institute of General Surgery,General Hospital of Eastern Theater Command,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院全军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2021年第6期362-367,375,共7页Parenteral & Enteral Nutrition

摘　　要：目的:本研究通过比较不同肠内营养给予途径肠瘘病人临床资料,旨在探究术前鼻胃管途径和鼻肠管途径对小肠瘘病人术后胃肠道功能恢复的影响。方法:回顾分析2015年1月至2019年6月东部战区总医院接受小肠瘘切除术的病人临床资料。根据术前肠内营养给予将病人分为鼻肠管组与鼻胃管组。探究不同给予途径对小肠瘘术后胃肠减压时间,术后排便时间与肠梗阻发生率进行比较。结果:共有151名病人被纳入此研究,49例病人为鼻胃管肠内营养组,其中术前行肠内营养支持123(I11,126)d。102例病人为鼻肠管组,术前行肠内营养支持120(10,129)d。术后病人平均胃肠减压时间为6(5,8)d,其中鼻胃管组4(4,5)d,而鼻肠管组7(6,8)d。术前使用鼻胃管饲通路行肠内营养支持对术后早期撤除胃肠减压存在积极影响(adjusted HR=2.488,95%CI:1.692~3.659,P<0.001)。术后平均排便气时间为4(4,6)d,其中鼻肠管组病人排便时间4(4,6)d,鼻胃管组病人排便时间为4(4,6)d。两组之间无显著性差异(adjusted HR=1.019,95%CI:0.808~1.282,P=0.814)。36例(23.84%)病人发生术后肠梗阻,其中鼻胃管组12例,鼻肠管组24例。两组之间无显著性差异(adjusted OR=1.118,95%CI:0.561~3.041,P=0.861)。结论:术前使用鼻胃管行肠内营养支持相较鼻肠管可缩短胃肠减压时间,但对降低术后排便时间及肠梗阻发生无明显效果。Objective:To investigate the effect of nasogastric tube and nasoenteric tube on the recovery of gastrointestinal function in patients with definitive surgery for small intestinal fistula.Methods:From January 2015 to June 2019,the clinical data of patients who underwent small intestinal fistula resection were reviewed.The enrolled patients were divided into nasoenteric tube group and nasogastric tube group according to preoperative enteral nutrition feeding route.The gastrointestinal decompression time,postoperative defecation time and the incidence of intestinal obstruction were investigated.Results:A total of 151 patients were included in this study,and 49 patients were included in the nasogastric tube group,with 123(111,126)days of preoperative enteral nutrition support.Other 102 patients were included in nasoenteric tube group,and received preoperative enteral nutrition was 120(110,129)days.The mean postoperative gastrointestinal decompression time was 6(5,8)days,including 4(4,5)days in the nasogastric tube group and 7(6,8)days in the nasoenteric tube group.Preoperative enteral nutrition via nasogastric tube feeding had a positive effect on early postoperative withdrawal of gastrointestinal decompression(adjusted HR=2.488,95%CI:1.692~3.659,P<0.001).The average postoperative defecation time was 4(4,6)days.There was no significant difference between the two groups(adjusted HR=1.019,95%CI:0.808~1.282,P=0.814).Postoperative intestinal obstruction occurred in 36 patients(23.84%),including 12 in the nasogastric tube group and 24 in the nasoenteric tube group.There was no significant difference between the two groups(adjusted OR=1.118,95%CI:0.561~3.041,P=0.861).Conclusion:Compared with nasoenteric tube,nasogastric tube might reduce the time of gastrointestinal decompression.But it has no obvious effect on reducing the postoperative defecation time and intestinal obstruction.

关 键 词：鼻胃管 鼻肠管 肠内营养 肠瘘 胃肠减压 

分 类 号：R656[医药卫生—外科学] R459.3[医药卫生—临床医学]