探讨基于加速康复外科理念下无胃肠减压在急性胰腺炎治疗中的临床效果研究

Study on the clinical effect of no gastrointestinal decompression in the treatment of acute pancreatitis based on the concept of enhanced recovery after surgery

目的:探讨基于加速康复外科理念下无胃肠减压在急性胰腺炎临床中的治疗效果。方法:120例急性胰腺炎患者随机分为两组,对照组常规予以禁食、胃肠减压、抑酸、抑酶规范化治疗,观察组采用加速康复外科理念未使用胃肠减压,余治疗方法相同。观察两组患者恶心呕吐、咽喉疼痛发生率,腹痛腹胀缓解时间、肛门排气排便时间,白细胞和血、尿淀粉酶恢复时间及住院天数等指标。正态分布的计量资料以x±s表示,两两比较采用独立样本t检验,计数资料比较采用χ^2检验。结果:筛选出符合研究条件的患者116例,观察组61例、对照组55例,观察组与对照组患者血淀粉酶下降至正常时间分别为(2.67±1.34)d、(3.20±1.30)d,两组比较,差异有统计学意义(t=-2.153,P<0.05)。观察组与对照组尿淀粉酶、白细胞下降至正常所需时间分别为(3.20±1.38)d、(3.77±2.16)d和(3.69±1.51)d、(4.20±2.28)d,两组比较,差异无统计学意义(t=-1.842,-1.043,P>0.05)。观察组与对照组腹痛腹胀、肛门排气排便、住院时间分别(1.92±0.71)d、(2.20±0.79)d、(8.16±2.75)d和(2.20±0.65)d、(2.76±0.94)d、(10.400±3.52)d,两组比较,差异有统计学意义(t=-2.216,-3.519,-3.837,P<0.05)。观察组与对照组出现咽喉疼痛例数分别是6例和23例,两组比较,差异有统计学意义(χ^2=15.78,P<0.05)。观察组与对照组恶心呕吐、肺部感染、吸入性肺炎分别是12、1、0例和18、2、1例,两组比较,差异无统计学意义(P>0.05)。结论:加速康复外科理念下无胃肠减压在急性胰腺炎,特别是水肿型急性胰腺炎在治疗过程中未使用胃肠减压是安全有效,咽喉疼痛发生率低、住院时间短等优点,同时可以减轻患者痛苦及减少侵袭性临床操作。

Objective:To investigate the effect of no gastrointestinal decompression in the clinical practice of acute pancreatitis based on the concept of enhanced recovery after surgery. Method:One hundred and twenty patients with acute pancreatitis were randomly divided into two groups. The control group was routinely treated with fasting, gastrointestinal decompression, acid suppression and enzyme inhibition. The observation group accepted enhanced recovery after surgery without gastrointestinal decompression. The remaining treatment methods are the same. The incidence of nausea and vomiting, sore throat, abdominal pain relief time, anal exhaust defecation time, white blood cell, blood, urine amylase recovery time and hospitalization days were observed. The measurement data of the normal distribution is represented by x±s, the comparison of the two pairs is performed by the independent sample t test, and the comparison of the count data is performed by χ^2 test. Result:The blood amylase decreased to normal level for(2.67±1.34) d and(3.20±1.30) d in the observation group and the control group, respectively. The difference was statistically significant(t=-2.153, P<0.05). The time required for urine amylase and leukocytes to fall to normal in the observation group and the control group were(3.20±1.38) d,(3.77±2.16) d, and(3.69±1.51) d,(4.20±2.28) d, respectively. The difference was not statistically significant(t=-1.842,-1.443, P>0.05). The abdominal pain and abdominal distension, anal exhaustion, hospitalization time were(1.92±0.71) d vs(2.20±0.79) d,(8.16±2.75) d vs(2.20±0.65) d,(2.76±0.94) d vs(10.400±3.52) d in observed group and control group, respectively, the difference was statistically significant(t=-2.216,-3.519,-3.876, P<0.05). The number of cases of sore throat in the observation group and the control group were 6 and 23, respectively. The difference was statistically significant(χ^2=15.78, P<0.05). The nausea and vomiting, pulmonary infection, and aspiration pneumonia in the observation group and the control group were 12, 1, 0, and 18, 2, and 1, respectively. There was no significant difference between the two groups(P>0.05). Conclusion:Enhanced recovery after surgery without gastrointestinal decompression in acute pancreatitis, especially edematous acute pancreatitis during the treatment without gastrointestinal decompression is safe and effective, low incidence of sore throat, short hospital stay, etc. Reduce patient suffering and reduce invasive clinical procedures.