胃肠道外营养在上消化道瘘早期治疗中的应用

The application of PN in the early stage treatment of upper digestive tract fistula

1980～1994年应用PN治疗上消化道109例的临床经验,对瘘早期临床表现:水、电解质、酸碱失衡,营养代谢障碍,瘘继发的腹腔感染及并发症进行讨论。在瘘的早期治疗中着重阐述PN营养支持对迅速纠正高位、高流量肠瘘所起的重要“人工肠道”作用,介绍开展PN治疗的技术和改进方法,提出减少PN治疗中并发症的防治意见。临床资料显示PN营养支持治疗比60年代瘘的自愈率提高了62％,死亡率明显下降到10％,缩短了临床治愈病程。

109 cases of upper digestive tract fistula were reported in this paper and all of them were treated by PN during the past 15 years. The various of causes, clinical materals of severe patients and the method technique of using PN were emphasisly analysed. The early stage symptoms of fistula were divided into three apects as following: (l)The unbalance of water, dielectric and acid-alkali. (2)The obstruction of nutrition metabolism. (3)Secondary infection of abdominal cavity. All of those aspects above-mentioned were discussed. In the early stage treatment, PN could rapidly correct the metabolic disorder of inner circulation caused by the intestinal fistula of high place and discharge. It could also improve the obstruction of nutrition metabolism in order to reduce the secrete of digestive juice. The clinical materials showed that PN played an important part of artifial tract, the cure rate increased 62 %, the mortality rate reduced to 10 % obviously and the duration of treatment was shorted. However, some complications were observed in the clinical treatment and we put forward the suggestion for preventing or avoiding the complications.