术后肠梗阻探讨

Study of the Postoperative Ileus

术后肠梗阻的临床表现为腹胀、腹痛、恶心、呕吐、不排便或不能耐受固体食物等,是手术无法避免的并发症之一。虽然人们对术后肠梗阻的病因进行了大量研究,但病因至今仍未完全明了。炎症和类阿片激动剂与术后肠梗阻的发生有关。应尽可能用腹腔镜替代开腹手术,术后尽早拔出鼻肠管和限制静脉输液量等手段可以预防或改善术后肠梗阻症状。外周选择性类阿片受体阻滞剂爱维莫潘是减轻术后肠梗阻临床症状和患者经济负担的新型药物。

The clinical characteristics of postoperative ileus （POI） include abdominal distention, pain, nausea, vomiting, non-defecation or un-tolerance solid diet. It remains an inevitable complication of surgery. Although the pathogenesis of delayed gastrointestinal transit in the postoperative period has been studied deeply, the cause of POI remains unclear. Inflammation and using of prolonged opioid analgesic contribute to POI. Clinical experience shows that the use of laparoscopy instead of laparotomy if possible, removal of nasogastric tubes shortly after surgery and restriction of intravenous fluids can prevent or ameliorate postoperative ileus. Peripherally selective opioid receptor antagonist （Alvimopan）is a new drug in treating POI.