结肠镜减压及肠道去污治疗脓毒症胃肠功能损伤的临床研究  

Clinical study of colonoscopy decompression and intestinal decontamination in treatment of gastrointestinal function injury in sepsis

作　　者：白奎[1] 刘雪艳 王路瑶 杨超[1] BAI Kui;LIU Xue-yan;WANG Lu-yao;YANG Chao(Intensive Care Unit,the First Affiliated Hospital of Henan University,Kaifeng,Henan 475000,China)

机构地区：[1]河南大学第一附属医院ICU,河南开封475000

出　　处：《医药论坛杂志》2023年第11期39-42,共4页Journal of Medical Forum

基　　金：开封市科技攻关计划项目(1803043)。

摘　　要：目的分析结肠镜减压与肠道去污干预对脓毒症胃肠功能损伤患者的治疗效果。方法抽样法选河南大学第一附属医院2019年7月至2022年8月收入的脓毒症合并胃肠功能损伤患者60例,按照随机数字表法将其分为对照组、观察组各30例。对照组予常规西医治疗,观察组在其基础上添加基于结肠镜减压的肠道去污干预,记录比较两组治疗前、治疗48 h后急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分、胃肠功能指标(肠鸣音次数、腹腔压力、平均胃潴留量)、肠黏膜屏障功能指标[二胺氧化酶(DAO)、血管活性肠肽(VIP)、D-乳酸]水平以及院内ICU住院时间、28 d病死率、多器官功能障碍综合征(MODS)发生率。结果治疗后两组APACHEⅡ评分降低,且观察组低于对照组(P<0.05)。治疗后两组肠鸣音次数升高,腹腔压力、平均胃潴留量降低,且观察组变化程度更明显(P<0.05)。治疗后两组DAO、VIP、D-乳酸均降低,且观察组低于对照组(P<0.05)。与对照组相比,观察组ICU住院时间更短,病死率与MODS发生率更低,差异有统计学意义(P<0.05)。结论结肠镜减压与肠道去污干预可显著改善脓毒症胃肠功能损伤患者临床病症、胃肠功能、肠黏膜屏障功能,减少住院时间,降低28d病死率与MODS发生率。Objective To analyze the therapeutic effect of intestinal decontamination intervention based on colonoscopy decompression on sepsis patients with gastrointestinal function injury.Methods Totally 60 patients with sepsis com-bined with gastrointestinal function injury from July 2019 to August 2022 in our hospital were selected by sampling meth-od,and they were divided into control group and observation group with 30 patients each according to random number ta-ble method.The control group was treated with conventional western medicine,while the observation group added intes-tinal decontamination intervention based on colonoscopy decompression,recorded and compared the scores of acute phys-iology and chronic health condition Ⅱ(APACHE Ⅱ),gastrointestinal function indicators(number of bowel sounds,ab-dominal pressure,gastrointestinal nutrition or food tolerance)Intestinal mucosal barrier function indicators diamine oxi-dase(DAO),vasoactive intestinal peptide(VIP),D-lactic acid levels,hospital stay in ICU,28 day mortality,and incidence of multiple organ dysfunction syndrome(MODS).Results After treatment,APACHE I score in both groups decreased,and those in the observation group were lower than those in the control group(P<0.05).After treat-ment,the number of bowel sounds increased and the abdominal pressure decreased in both groups,and the degree of change in the observation group was more obvious(P<0.05).After treatment,the proportion of gastrointestinal nutri-tion or food tolerance in the observation group was higher than that in the control group(P<0.05).After treatment,DAO,VIP and D-lactic acid in both groups were decreased,and those in the observation group were lower than those in the control group(P<0.05).Compared with the control group,the ICU hospitalization time in the observation group was shorter,the case fatality rate and the incidence of MODS were less,and the difference was statistically significant(P<0.05).Conclusion Colonoscopy decompression and intestinal decontamination intervention can significant

关 键 词：结肠镜减压 肠道去污 脓毒症 胃肠功能损伤 疗效 

分 类 号：R631[医药卫生—外科学]