床旁盲插经鼻型肠梗阻导管联合续贯肠内营养治疗粘连性小肠梗阻的疗效  

The efficacy of adhesive small bowel obstruction treated with blind insertion of nasal intestinal obstruction catheter combined with continuous enteral nutrition

作　　者：何杨 侯志冰 王烈 宋京翔 王瑜 HE Yang;HOU Zhibing;WANG Lie;SONG Jingxiang;WANG Yu(Department of Gastrointestinal Surgery,the 900th Hospital of Joint Logistic Support Force,PLA,Fuzhou 350000,Fujian,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇〇医院(原南京军区福州总医院)胃肠外科病区,福建福州350000

出　　处：《实用医学杂志》2025年第8期1175-1180,共6页The Journal of Practical Medicine

基　　金：福建省自然科学基金面上项目(编号:2020J011139,2021J011262);全军医学科技青年培育项目拔尖项目(编号:21QNPY138);联勤保障部队第九〇〇医院院内课题(编号:2020L12);福建医科大学科研发展基金项目(编号:2021QH1323)。

摘　　要：目的探究盲插经鼻肠梗阻导管联合肠内营养(EN)治疗粘连性小肠梗阻的疗效。方法收集2022年1月至2023年12月收治的粘连性小肠梗阻患者资料。分成观察组(A组,n=42)及对照组(B组,n=37),A组床旁盲插经鼻肠梗阻导管减压,B组胃管减压,肠梗阻解除后行肠内营养,比较两组患者治疗前后营养、腹部改善、炎症及并发症指标。结果营养方面,在第7天的Alb、Pa及NRS2002评分上,A组明显优于B组,差异有统计学意义(P<0.05);腹部改善方面,在日均减压引流量、日均腹围减少量、腹胀腹痛缓解时间、恢复排气时间、恢复排便时间、恢复EN时间及总住院时间上,A组明显优于B组,差异有统计学意义(P<0.05);炎症方面,治疗后第4、7天的CRP、IL-6、WBC,A组优于B组,差异有统计学意义(P<0.05);并发症方面,在腹胀及腹泻等EN不耐受、反流及保守无效中转手术上,A组优于B组,差异有统计学意义(P<0.05),在水电解质紊乱上,B组优于A组,差异有统计学意义(P<0.05)。结论床旁盲插经鼻肠梗阻导管联合肠内营养治疗粘连性小肠梗阻是安全、有效的,值得临床推广。Objective To investigate the efficacy of treating adhesive small intestinal obstruction using blind insertion of a nasal ileus catheter in combination with continuous enteral nutrition.Methods The data of patients with adhesive small intestinal obstruction admitted to our department from January 2022 to December 2023 were retrospectively collected.Group A was treated with blind insertion of a nasal jejunal decompression catheter,whereas Group B was managed with a nasogastric tube.Continuous enteral nutrition was initiated after the resolu-tion of intestinal obstruction in both groups.The nutritional indices,abdominal improvement,inflammatory markers,and complication rates were compared between the two groups before and after treatment.Results In terms of nutritional indices,the scores for Alb,Pa,and NRS2002 in Group A were significantly higher than those in Group B on the 7th day(P<0.05).Regarding abdominal improvement indices,Group A demonstrated significantly better outcomes than Group B in daily average decompression drainage volume,daily average reduction in abdominal circumference,relief time for abdominal distension and pain,recovery time for exhaust,defecation,time to resump-tion of enteral nutrition,and total hospitalization duration(P<0.05).Concerning inflammatory indices,CRP,IL-6,and WBC levels in Group A were significantly lower than those in Group B on both the 4th and 7th days post-treatment(P<0.05).With regard to complications,Group A exhibited fewer cases of EN intolerance,reflux,and conversion due to conservative treatment ineffectiveness compared to Group B(P<0.05).Conversely,Group B had fewer instances of water and electrolyte imbalance compared to Group A(P<0.05).Conclusion Adhesive small intestinal obstruction treated with blind insertion of a nasal ileus catheter combined with continuous enteral nutrition is a safe and effective approach,making it worthy of promotion in clinical practice.

关 键 词：粘连性小肠梗阻 盲插 经鼻型肠梗阻导管 肠内营养 

分 类 号：R459.3[医药卫生—治疗学]