术后胃瘫综合征的营养支持和临床治疗

The nutritional support and management of postoperative gastroparesis syndrome

目的总结术后胃瘫综合征的营养支持及治疗方法。方法回顾并分析我院普外科收治的62例术后胃瘫综合征患者的临床资料。结果患者出现症状时间为术后4～18d,平均(7.5±1.1)d。所有患者均给予胃肠减压、营养支持、高渗盐水洗胃、应用促胃动力药物等治疗,部分患者给予腹部理疗及心理干预,1例再次手术切除全胃,1例行经皮内镜下胃/空肠造口术治疗。治疗过程中无死亡病例,所有患者均于发病后6～45d,平均(20.1±2.7)d后恢复胃功能。结论术后胃瘫综合征的发生是多因素导致的结果,治疗可采用营养支持和促胃动力药物为主的个体化治疗,患者一般都可痊愈。再次手术会导致患者住院时间延长,增加患者的心理和经济负担,增加治疗风险。

Objective To summarize the nutritional support and management of postoperative gastroparesis syndrome （PGS）. Method The clinical data of 62 cases of PGS over the past decade in our department were retrospectively analyzed. Results The symptoms occurred in 4 to 18 days （average：7.5 ± 1.1 days） after operation. The most frequently clinical manifestation of PGS included gastric juice with bile from nasogastric tube or abdominal fullness, nausea and frequent vomit. Some cases presented postprandial fullness and vomiting of gastric contents after liquid diet. The management included gastrointestinal decompression, nutritional support, gastric lavage, abdominal physiotherapy, prokinetic drugs and psychological interventions. One case received total gastrectomy, and one case percutaneous endoscopic gastrostomy or jejunostomy. Hospital mortality was zero. Gastric function of all cases was recovered in 6 to 45 days （average ：20.1 ± 2.7 days）. Conclusion PGS is attributed to a variety of reasons. Management of PGS is focused on nutritional support and nonoperative therapy, and individualized care is preferred. Operative treatment is not advocated because of the multiple hospitalizations, psychological dysfunction and high costs, and it can also increase the risk of management.