灌注治疗肠梗阻258例分析

ANALYSIS OF THE APPLICATION OF PERFUSION TO 258 PATIENTS WITH INTESTINAL OBSTRUCTION

目的 探讨绞窄性肠梗阻的早期诊断 ,减少或避免肠坏死和穿孔的发生 ,降低死亡率的方法。方法 经胃肠减压管注入豆油 150ml,2～ 3次 d ,经肛管灌注 1 2 3液 (即 33%MgSO4 30ml、甘油 60ml、温生理盐水 90ml、180ml或 360ml。每 30min记录观察结果。如发现病人胃肠减压吸引的液体有异常 ,甚至生命体征有变化 ,腹胀、腹痛及呕吐加重 ,呕吐物及肛门排出物的性状、颜色、数量有异常时 ,视为肠绞窄 ,立即进行手术。反之如果自觉症状减轻 ,一般情况有改善 ,说明肠梗阻有缓解趋势 ,继续进行观察。连续灌注治疗 1～ 3d ,梗阻仍不能缓解 ,即视为有手术指征。结果 2 58例病人 ,经 1次灌注治疗确立手术者 143例 ,其中肠绞窄 76例 ;经 2～ 3次灌注确立手术者 4 7例 ;免除手术者 68例。无 1例延迟手术或耽误治疗 ,均获痊愈。结论 本法简易、安全、有效。为肠梗阻的正确治疗提供了可靠的依据 。

Objective To explore early diagnosis of strangulated intestinal obstruction so as to avoid the occurrenes of intestinal necrosis and perforation and to reduce the death rate.Methods Soyabean oil (150ml) was perfused two or three times a day through gastrointestinal decompression duct,and the lavage solution (180ml or 360ml) made from MgSO 4 (33%),glycerin and warm physiological saline at the ratio of 123 was perfused through anal canal.The results were observed and recorded every 30 minutes .When abnormality occurred during gastrointestinal decompression and even when vital signs changed,such as exacerbation of abdominal distension and pain,the changes in characteristics,color and quantity of the vomit and discharge,intestinal strangulation should be confirmed and immediate operation should be performed.On the other hand,if the subjective symptoms were relieved and the general conditions were improved,it showed that intestinal obstruction was reliveed and should receive further obsevation.If 13 day's continuous perfusion could not yet relieve intestinal obstruction,the patients were supposed to have operative indices.Results According to this method,143 of 258 cases were supposed to receive operation after the lst perfusion of which 76 cases suffered from intestinal obstruction.47 cases were supposed to go through operation after the 2nd or 3rd perfusion and 68 cases were found to have no need to be operated on.All these patients recovered without any delay.Conclusion This approach is believed to haveprovided reliable information about the treatment of intestinal obstruction for its simplicity,safety,good effects and practical value.