肠梗阻导管联合早期肠内营养对粘连性肠梗阻的治疗效果观察

目的 探讨肠梗阻导管联合早期肠内营养对粘连性肠梗阻的治疗效果。 方法 收集胃肠外科2012年1月-2015年12月收治的粘连性肠梗阻患者54例。其中男性22例,女性32例;平均年龄(66.8±12.4)岁,随机分为对照组(27例)和观察组(27例),对照组患者接受常规治疗,包括胃管减压、纠正水电解质和酸碱平衡、肠外营养、生长抑素抑制消化液分泌;观察组患者在常规治疗的基础上,经胃镜辅助置入经鼻型肠梗阻导管行小肠减压,观察该导管前置水囊开始下移后即给予早期肠内营养,观察患者的营养学指标、免疫力指标、临床治疗指标及治疗效果。 结果 治疗1周后,观察组患者的血清前白蛋白、转铁蛋白、体质量均高于对照组;观察组水平CD3+、CD4+、CD8+、CD4+/CD8+高于对照组,差异有统计学意义(P<0.05);观察组腹痛缓解时间、首次排便时间、首次排气时间、住院时间均显著低于对照组,差异有统计学意义(P<0.05);观察组治愈数17人,好转8人,无效2人,有效率92.6%,对照组治愈8人,好转10人,无效9人,有效率66.7%%,观察组的有效率高于对照组(P<0.05)。 结论 肠梗阻导管联合早期肠内营养可以改善粘连性肠梗阻患者的营养状况,提高患者的免疫力,促进患者肠功能的早期康复,具有一定的临床应用价值。 

Observation on therapeutic effects of ileus tube placement combined with the early enteral nutrition on adhesive ileus

Objective To investigate therapeutic efficacy of ileus tube placement combined with theearly enteral nutrition on adhesive ileus. Methods A randomized controlled trial was carried out.A total of 54 patients with adhesive ileus admitted to the department of gastroenterological surgery in our hospital from January,2012 to December,2015 were randomly divided into the control group (n=27) and the observation group (n=27),including 22 cases male and 32 cases of female with an average age of (66.8±12.4).The control group received a conventional treatment including gastrointestinal decompression,correction of water-electrolyte and acid-based balance,parenteral nutrition and somatostatin by inhibiting the secretion of digestive juices,on the basis of which the observation group was given a ileus tube placement aided by gastroscope through nose to decompress the small intestine,and early enteral nutrition when the prepositive water sac started to move down.Patients were observed for their nutritional index,immunity index and clinical treatment index as well as therapeutic effects. Results One week after the operation,the pre-albumin,the transferring and body mass of the observation group were higher than those of the control group,while the levels of CD3+,CD4+,CD8+,CD4+/CD8+ in the observation group were significantly higher than those in control group (P<0.05).The observation group was significantly shorter than control group in the relief of abdominal pain,abdominal distention,flatus,first anal defecation and hospital stays (P<0.05).The effective rate of the observation group was 92.6% with 17 healing,8 improving and 2 failure cases,while the effective rate of the control group was 66.7% with 8 healing,10 improving and 9 failure cases.The overall efficiency of observation group was significantly higher than that of control group (P<0.05). Conclusion Ileus tube placement combined with the early enteral nutrition on adhesive ileus significantly improved the nutritional status of patients,enhanced the body immunity and accelerated the recovery of patients.