小儿腹部外科急性胃肠功能衰竭的治疗（附43例分析）

目的探讨小儿腹部外科急性胃肠功能衰竭的治疗方案。方法 2000年2月至2010年2月小儿腹部外科出现急性胃肠功能衰竭病人,给予胃肠减压,应用大黄促进胃肠蠕动,抑酸剂抑制胃酸分泌,胃肠道出血后行止血治疗,并进行改善微循环、控制感染、营养支持等处理。结果全部病例43例,死亡18例,死亡率41.86%。其中早期干预胃肠功能障碍23例,死亡6例,死亡率为26.09%;晚期干预组20例,死亡12例,死亡率为60.00%,两组比较,差异有统计学意义（χ2=5.05,P〈0.05）。大黄组15例,死亡3例,死亡率为20.00%;非大黄使用组28例,死亡15例,死亡率为53.57%,两组比较,差异有统计学意义（χ2=4.52,P〈0.05）。本组均有上消化道出血,胃内用止血药16例,3例死亡;单纯静脉应用立止血、抑酸剂等药27例,死亡15例,显示胃有出血时从胃内用药明显优于单纯静脉用药（χ2=5.59,P〈0.05）。结论对小儿腹部外科危重症儿胃肠功能衰竭的早认识,早干预,采用胃肠减压、应用大黄、出现上消化道出血后应从胃管注入止血药等综合治疗措施,是降低病死率的关键。

Treatment of Acute Gastrointestinal Failure in Pediatric Abdominal Surgery

Objective To study the cause of acute gastrointestinal failure in children receiving Pediatric Abdominal Surgery.Methods Between 2000 to 2010, children receiving Pediatric Abdominal Surgery and suffer from acute gastrointestinal failure were given gastrointestinal decompression, rhubarb to promote gastrointestinal peristalsis, antacid to inhibit gastric acid secretion and gastrointestinal hemostasis therapy （if bleeding）.Other methods in the disease management included the improvement of microcirculation, controlled infection and nutritional supported etc.Results There were 43 cases of gastrointestinal failure.18 cases of death and the mortality rate was 41.86%.23 subjects received early intervention of gastrointestinal dysfunction and 6 cases of deaths （26.09%）.20 subjects received late intervention and 12 patients died （60.00%）.The difference between these 2 groups was statistically significant （P 0.05）.15 subjects received Rhubarb treatment and 3 death cases were noted （20.00%）.28 subjects received non-rhubarb treatment and 15 cases of death （the mortality rate was 53.57%）; the result was statistically significant difference from the rhubarb treatment group （P0.05）.All subjects had upper gastrointestinal bleeding and 16 subjects received gastrointestinal hemostasis therapy.3 death cases were noted.27 subjects received simple intravenous reptilase and acid-suppressing drug and 15 cases of death were noted.The result was statistically significantly difference from the group receiving gastrointestinal hemostasis （P0.05）.Conclusion Early understanding, early intervention, using gastrointestinal decompression, rhubarb and injection of hemostatic drugs using gastric tube can lower the mortality of critically ill children with gastrointestinal failure and receiving pediatric abdominal surgery.