嚼口香糖对腹部手术后肠动力恢复的影响及作用机制研究

The influence of chewing gum on the return of intestinal motility after abdominal surgery in children and its mechanism of action

目的探讨儿童腹部手术后咀嚼口香糖是否能促进肠动力的恢复,并从神经和体液两方面因素来研究其作用机制。方法将34例肠吻合手术患儿,随机分为试验组和对照组,每组各17例。试验组于术后第1天晨开始咀嚼无糖口香糖,直至开始进食,每日3次,每次1h,对照组禁食。记录两组术后第1次肛门排气时间,并于第3次咀嚼口香糖后1h抽取血液检测胃泌素和儿茶酚胺(包括去甲肾上腺素和肾上腺素),对两组术后第1次排气时间、血胃泌素及儿茶酚胺水平进行统计学分析。结果试验组术后第1次肛门排气时间为术后63h,对照组为78h,差异有统计学意义(t=5.665,P<0.05)。试验组去甲肾上腺素水平低于对照组,差异有统计学意义(t=3.335,P<0.05),而两组肾上腺素(t=1.201,P>0.05)及胃泌素(t=0.418,P>0.05)比较,差异无统计学意义。结论根据假饲原理,腹部手术患儿术后嚼口香糖有助于肠功能的早日恢复,其作用机制与血去甲肾上腺素水平降低有关。

Objective To study the influence of chewing gum on the return of intestinal motility after abdominal surgery in children and its acting mechanism from two aspects of neural and humoral factors. Methods Eighteen patients were enrolled in our study. Each patient underwent a intestinal anastomosis and was then assigned randomly to the gum-chewing group （n=17） or control group （n=17）. The patients in the gum-chewing group chewed sugarless gum three times daily for 1 hour each time in the morning, afternoon and evening from the first postoperative morning until the day they began oral intake. The time of first passage of flatus was recorded for evaluating the return of bowel movement. The blood samples were taken immediately after the 3rd gum-chewing for detecting the level of gastrin and catecholamine （including norepinephrine and epinephrine）. Results The first passage of flatus ocurred on postoperative 63 hours in gum-chewing group, which was significantly sooner than the postoperative 78 hours in the control group （t = 5.665 ,P 〈 0.05）. There was significant difference ofnorepinephrine between two groups （t = 3.335, P〈 0.05）; However, there was no significant difference of epinephrine between two groups （t = 1.201, P 〉 0.05）. The value of blood gastrin showed no significant difference between two groups （t = 0.418 ,P 〉 0.05）, Conclusions Chewing gum can hasten the return of intestinal function after abdominal surgery in children. According to our study data, the mechanism is related to the level of blood norepinephrine, but it is no/related to the level of blood gastrin and catecholamine.