复方泛影葡胺对粘连性小肠梗阻早期手术的预测

目的:探讨口服76％复方泛影葡胺24小时后腹部平片对粘连性小肠梗阻治疗方法的选择是否可作为一个可靠指征。方法:对171例无绞窄情况的粘连性肠梗阻患者进行了本研究。40ml 76％复方泛影葡胺×40ml蒸馏水口服或经胃管注入。4、8、16、24小时拍腹部平片。如果4小时腹部平片升结肠显影,后序平片无需再拍。结果:24小时内造影剂到达结肠120例(70％),这些病人均成功地进行了保守治疗。51例病人24小时内造影剂未到达结肠,49例进行了手术治疗,2例保守治疗。结论:24小时内结肠显影的病人均成功地进行了保守治疗。提示口服复方泛影葡胺后24小时造影剂未到达结肠者需急诊手术治疗。     

泛影葡胺和精细护理用于粘连性肠梗阻的疗护效果观察

目的探讨对粘连性肠梗阻患者采用76%泛影葡胺和全程精细护理的效果。方法对精细疗护组64例粘连性肠梗阻患者,先予禁食、胃肠减压、清洁灌肠、抑制消化液分泌、抗感染、营养支持等治疗4～6h后无效,经胃管注入76%泛影葡胺60～100ml,同时做好患者的心理护理、病情观察、胃肠减压和灌肠护理及加强饮食指导,并与一般疗护组64例作对比分析。结果精细疗护组64例痊愈出院率92.19%,中转开腹手术率7.81%,明显优于一般疗护组之57.81%、42.19%。结论粘连性肠梗阻应用泛影葡胺并进行精细护理,可以降低手术率,提高治愈率。     

复方泛影葡胺对粘连性小肠梗阻早期手术的预测

目的 探讨口服76％复方泛影葡胺24小时后腹部平片对粘连性小肠梗阻治疗方法的选择是否可作为一个可靠指征。方法 对171例无绞窄情况的粘连性肠梗阻患进行了本研究。40ml 76％复方泛影葡胺 40ml蒸馏水口服或经胃管注入。4、8、16、24小时拍腹部平片。如果4小时腹部平片升结肠显影,后序平片无需再拍。结果 24小时内造影剂到达结肠120例(70％),这些病人均成功地进行了保守治疗。51例病人24小时内造影剂未到达结肠,49例进行了手术治疗,2例保守治疗。结论 24小时内结肠显影的病人均成功地进行了保守治疗。提示口服复方泛影葡胺后24小时造影剂未到达结肠需急诊手术治疗。     

两次泛影葡胺鼻饲在判断粘连性肠梗阻手术指征中的意义

目的探讨两次泛影葡胺鼻饲在判断粘连性肠梗阻(ATO)手术指征中的意义。方法对30例经胃管两次注入泛影葡胺的粘连性肠梗阻病例资料进行回顾性分析。结果本组共30例患者,其中7例经第2次泛影葡胺给药后24 h内肠梗阻缓解,4例患者因怀疑或出现肠绞窄征象改为手术治疗。其余19例经两次泛影葡胺给药后肠梗阻仍未缓解、但无绞窄征象的病例接受了手术治疗。术中均发现了需要手术才能解决的粘连问题,经手术治疗效果满意。结论经两次泛影葡胺鼻饲后粘连性肠梗阻不能缓解者,尽管可能还未出现绞窄性肠梗阻的表现,也宜尽早手术。本研究结果为判断非绞窄性粘连性肠梗阻的手术指征提供了一个简单的方法。     

泛影葡胺联合万古霉素对粘连性肠梗阻患者的疗效及患者炎性介质水平的影响

目的探讨泛影葡胺联合万古霉素对粘连性肠梗阻患者的疗效及患者炎性介质水平的影响。方法选取2017年4月至2018年4月衢州市常山县人民医院收治的粘连性肠梗阻患者96例,对照组单独应用泛影葡胺治疗,研究组联合应用泛影葡胺和万古霉素治疗。评估两组患者的疗效和炎性介质表达水平。结果研究组的疗效显著优于对照组(P0.05)。研究组的排气、排便恢复时间,胃肠减压时间,腹痛、腹胀症状缓解时间,总治愈用时,胃肠减压引流量以及主诉疼痛程度分级法(VRS)分级情况均优于对照组(P0.05)。治疗后,两组的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及IL-8水平较治疗前显著降低,且研究组显著低于对照组(P0.05)。研究组的机体应激反应情况以及电解质紊乱情况均显著轻于对照组(P0.05)。结论联合应用泛影葡胺和万古霉素治疗粘连性肠梗阻患者,有助于提高疗效,减轻炎性反应,值得在临床上推广应用。     

肠梗阻导管联合泛影葡胺治疗儿童腹腔术后早期肠梗阻

目的 评估肠梗阻导管联合泛影葡胺在儿童腹腔术后早期肠梗阻治疗中的价值。方法 回顾性收集2014年8月至2022年12月于徐州市中心医院接受X线引导下肠梗阻导管置入联合泛影葡胺治疗的8例腹腔术后早期(30天内)肠梗阻患儿临床资料,分析置管成功率、症状缓解率、梗阻解除率、梗阻解除时间、肠梗阻导管留置时长、随访复发结果及置管并发症。结果 置管成功率、症状缓解率及梗阻解除率均为100%(8/8);梗阻解除平均时长3.75±1.58天;肠梗阻导管留置平均时长6.63±2.13天;随访时间最短者1个月,最长者93个月,复发率12.5%(1/8);置管并发症包括鼻部疼痛、鼻腔少量出血以及轻度的恶心、呕吐。结论 肠梗阻导管联合泛影葡胺治疗儿童腹腔术后早期肠梗阻安全、有效、复发率低、并发症轻微。     

泛影葡胺在子宫输卵管造影中的应用

自1988年以来，我们采用泛影葡胺行子宫输卵管造影300例，效果满意。现报告如下。     

泛影葡胺、碘油用于子宫输卵管造影效果比较

为探讨泛影葡胺和碘油在子宫输卵管造影中的应用价值及性能特点，1998-2003年，我们对86例同居1年以上未孕患者分别用76％泛影葡胺和40％碘油行子宫输卵管造影。现总结如下。     

口服泛影葡胺致不良反应1例报告

患者女,44岁。因反复腰痛1a、加重7d人院。患者1a前无明显诱因出现腰部酸痛,无尿频、尿急、尿痛,未正规服药治疗,病情时轻时重。7d前无明显诱因上述症状加重,     

不同推注速度对泛影葡胺副反应的影响

泛影葡胺作为静脉肾盂造影时常用的造影剂，所产生的副反应一直为人们所重视，其常见的副反应轻者为全身发热，恶心、呕吐、荨麻疹等，重者为喉头水肿，过敏性休克。本文通过临床实践观察，发现不同推注速度对泛影葡胺副作用的发生率有一定的关系，现总结如下。     

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.     

吸痰三通管在人工气道患者雾化吸入中的应用

目的　评价吸痰三通管在人工气道患者雾化吸入中的应用价值。方法　选择建立了人工气道雾化吸入治疗的患者 79例 ,分为实验组与对照组 ,实验组雾化吸入时应用呼吸机专用吸痰三通管 ,对照组则直接把雾化器的口鼻面罩罩在人工气道口上进行雾化。结果　实验组与对照组的 SPO2 监测值在雾化前后总有效率分别为94 %、5 4 % ,而雾化吸入沐舒坦前后总有效率分别为 89%、5 7% ,雾化吸入解痉平喘剂前后总有效率分别为 93%、5 5 %。结论　将呼吸机专用的吸痰三通管应用于人工气道患者的雾化吸入中 ,能达到雾化吸入治疗应有的效果。     

A paediatric tube and capsule for suction biopsy of the small intestinal mucosa designed for direct nasogastric intubation

The use of a modified paediatric tube and capsule for suction biopsy of the mucosa of the small intestine is discussed. The tube is small in diameter and can be introduced through the nose without local trauma and with minimal discomfort. The intubation technique was followed in 72 instances to obtain suction biopsies from the proximal mucosa of the small intestine in protein-calorie malnourished children, and the results obtained with this instrument are also presented.     

Chronic adhesive lupus serositis as a complication of systemic lupus erythematosus. Refractory chest pain and small-bowel obstruction

Serious clinical sequelae of lupus serositis are uncommon and rarely a cause of morbidity. We describe two patients, one with chronic adhesive pericarditis and one with extensive small-bowel adhesions due to lupus peritonitis. In both, delayed institution of adequate prednisone therapy may have played a contributing role.     

Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction

OBJECTIVE: To investigate the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction. PATIENTS AND METHODS: One hundred and sixty-two consecutive patients who had suffered from adhesive intestinal obstruction without clinical evidence of strangulation or gangrene were randomised into two groups, a control group (treated conservatively, n=82) and a contrast group (treated with combined administration of octreotide and methylglucamine diatrizoate, n=80). A laparotomy was performed in both the two groups if symptoms of strangulation developed or the obstruction did not resolve spontaneously after 72 h. RESULTS: Statistically significant rapid reduction in pain score, lower amount of nasogastric drainage, shorter hospital stay, lower operative rate and lower postoperative morbidity were observed in the contrast group. Among the non-operative patients, earlier passage of stool and gas, earlier first oral intake and shorter duration of nasogastric tube placement were significantly more frequently observed in the contrast group. No difference in the rate of readmission was found between the two groups. CONCLUSIONS: Combined administration of octreotide and methylglucamine diatrizoate accelerates resolution of small bowel obstruction by a specific therapeutic effect and is safe for the older persons.     

Efficacy and timing of gastrografin administration after ileus tube insertion in patients with adhesive small bowel obstruction

Background and study aimsGastrografin administration (GA) is performed for adhesive small bowel obstruction (ASBO) in cases when decompression therapy using an ileus tube fails to relieve the obstruction. This study evaluated the efficacy of GA and optimized its timing after ileus tube insertion.Patients and methodsIn this retrospective study, we evaluated data from patients with ASBO admitted between January 2014 and August 2018 and included patients who underwent ileus tube intubation and GA. The patients were classified as those treated with GA within 48 h after admission (early GA [EGA]) and those treated later with GA (delayed GA [DGA]). Propensity score matching was performed to compensate for differences between the groups. Short-term outcomes were compared between the two groups.ResultsWe included 67 and 80 patients in the EGA and DGA groups, respectively, and 55 pairs with similar background characteristics were matched. The rates of successful conservative management were 87.3% (48/55) in the EGA group, 96.4% (53/55) in the DGA group, and 91.8% (101/110) in the entire sample. The median period of ileus tube insertion in the DGA group was significantly lower than that in the EGA group, whereas other outcomes did not significantly differ between the groups. Aspiration pneumonia occurred in one patient in the EGA group.ConclusionsGA with an ileus tube achieved a high rate of successful conservative management. Follow-up using decompression with an ileus tube for at least 48 h after admission is recommended in patients with ASBO.     

Comparison of fasting, nasogastric suction and cimetidine in the treatment of acute pancreatitis

88 unselected patients with acute pancreatitis entered a randomized clinical trial comparing the therapeutic efficacy of fasting alone, nasogastric suction and fasting plus cimetidine. The disease was mild to moderate in all but 3 cases, and cholelithiasis was the main etiological factor. The number of treatment failures and complications, and the clinical outcome were similar in the three groups. However, when compared to fasting alone, nasogastric suction was shown to delay the resumption of bowel activity a mean of 11 h (p less than 0.05), prolong the duration of pain a mean of 20 h (p less than 0.01), increase analgesic needs (pentazocine lactate) a mean of 64 mg (p less than 0.05), and lengthen hospital stay a mean of 2 days (p = NS). In conclusion, cimetidine has no beneficial effects in acute pancreatitis. It is suggested that fasting alone be initially used as the simpler, safer and more economical therapy. Nasogastric suction should be reserved for patients presenting with intestinal ileus, a situation that occurred in 1 out of every 8 cases in the present series.     

Knot formation in a long tube used in the treatment of a post-operative adhesive small bowel obstruction

The complications specific to the management of the nasointestinal long tubes for small bowel obstruction are not generally appreciated. We report here of a case of knot formation of the long tube which was inserted for a 60 year-old male. Because it was difficult to place the tube in the distal stomach despite frequent changes in patient position, two coiled loops were noted at the fornix as the tip of the tube reached the antrum. The tube was gently removed without injury to the esophagus or stomach under fluoroscopic control. This case illustrates that when a long tube is used, the formation of multiple coils in the stomach should be avoided during placement to prevent knotting. Furthermore, a knotted tube can be gently removed non-operatively without esophageal injury. A short tube may be superior to a long tube because most of the complications can be avoided.     

经鼻胃镜放置肠梗阻导管治疗粘连性小肠梗阻的临床应用

我们将鼻胃镜经鼻插入28例粘连性小肠梗阻的患者十二指肠降段,经活检孔引入亲水性超滑导丝至空肠,退出鼻胃镜,将肠梗阻导管沿导丝送入空肠上段,充盈前气囊后,观察患者治疗前后症状有无缓解、腹围缩小情况及24 h引流量等指标。结果 显示28例患者均1次置管成功,成功率100%。置管时间为10～35 min,留管时间为3～18 d。术中均无并发症发生。患者临床症状均有不同程度改善;24 h引流量480～1 550 mL,平均885 mL;置管24 h后患者腹围（79.1%±20.3%）显著小于置管前（100%,P〈0.05）。可见经鼻胃镜放置肠梗阻导管简便、易行,治疗粘连性小肠梗阻疗效确切,应作为治疗粘连性小肠梗阻的首选方法。