短肠综合征的康复治疗

目的总结27例短肠综合征病人康复治疗的经验，介绍短肠康复治疗的具体方法，探讨改善短肠病人营养状况、促进肠功能代偿的措施。方法短肠康复治疗包括营养支持、应用谷氨酰胺和生长激素促进肠粘膜生长、富含膳食纤维的短肠康复饮食、减轻短肠临床症状以及预防和治疗短肠并发症等措施。1997年1月至2000年7月间共27例短肠患者接受了29次康复治疗，患者平均年龄38.5岁±19.3岁。剩余小肠长度范围15～80cm，平均46.8cm±23.4cm，15例有回盲瓣。从肠切除至接受康复治疗的平均时间为86d±105d。结果治疗后病人的营养状况明显改善，肠道吸收功能有所增强。随访超过2年者8例，4例完全脱离肠外营养，随访时间超过1年者13例，有10例完全脱离肠外营养。结论短肠康复治疗能够有效地改善短肠病人的营养状况、并能促进肠功能代偿，治疗效果与残留小肠长度、治疗开始的时间和病人年龄有关，及早进行康复治疗能够促进肠功能代偿，减少病人对肠外营养的依赖。

Rehabilitation therapy for short bowel syndrome

OBJECTIVE: To investigate the effect of rehabilitation therapy for short bowel syndrome on patients' nutritional status and intestinal adaptation. METHODS: Twenty seven patients with short bowel syndrome with the average age of 38.5 +/- 19.3 years, the residual small intestine of the length of 15 to 80 cm, ileocecal valve being preserved in 15 cases, and an average time between the onset of short bowel syndrome and rehabilitation therapy of 86 +/- 105 d received 29 courses of rehabilitation therapy including enteral or parenteral nutrition, glutamine, recombinant human growth hormone and rehabilitation diet from January 1997 to July 2000. RESULTS: After the treatment, the patients' nutritional status improved markedly, their intestinal absorptive capacity improved too. Eight patients were followed up for more than 2 y, 4 of them (50%) had weaned from total parenteral nutrition. Thirteen patients were followed up for more than 1 y, 10 of them (76.9%) had weaned from total parenteral nutrition. CONCLUSION: Rehabilitation therapy for short bowel syndrome improves patients' nutritional status effectively and promote intestinal adaptation. Early initiation of rehabilitation therapy promotes intestinal adaptation, and increases patients' liability to wean from total parenteral nutrition.