有效肠减压在肠梗阻急诊处理中的效果观察

Effective intestinal decompression in the treatment of acute intestinal obstruction: Therapeutic effect observation

目的归纳总结一套急性肠梗阻的规范化的治疗方案,减少盲目手术和手术探查阴性率。方法回顾性分析2005-02～2008-06急诊收治的239例肠梗阻患者行有效肠减压的治疗效果。结果 239例患者中,196例患者在有效减压12h后症状缓解或好转,总的缓解或好转率为82.0%。43例患者在保守治疗无效行急诊手术,总的急诊手术率为18.0%。108例患者完善相关检查,明确诊断后行手术治疗,总的手术率为45.2%。56例粘连性肠梗阻,8例动力性肠梗阻,2例炎性肠病,2例血运性肠梗阻（结合溶栓治疗）和20例不明原因的肠梗阻经保守治疗痊愈,总的保守治疗有效率为36.8%。结论有效的减压治疗可作为急性肠梗阻的常规治疗措施,广泛使用于除外绞窄性肠梗阻的大多数肠梗阻患者。特别是在急诊条件下检查不完善时,诊断困难及原因不明的肠梗阻。

Objective To sum standardized treatment of acute intestinal obstruction, so as to reduce the blind operation and the rate of negative surgical exploration. Methods A retrospective analysis of 239 emergency cases of intestinal obstruction who received effective decompression treatment from February, 2005 to June 2008 was made. Result Among the 239 patients 196 were effective in the decompression after 12 hours, the symptoms improved or alleviated, the overall rate of improvement in mitigation was 82.0 percent; 43 after the conservative treatment being ineffective received emergency surgery; the overall rate of emergency surgery was 18.0 percent; in 108 patients through sound-related inspections, a clear diagnosis was made then received surgery, general surgery rate was 45.2 percent; 56 cases of adhesive intestinal obstruction, 8 cases of dynamic intestinal obstruction, 2 cases of inflammatory bowel disease, 2 cases of mesenteric vascular obstruction （combined with thrombolytic therapy） and 20 cases of unexplained intestinal obstruction by using conservative treatment obtained complete cure, the overall conservative treatment efficiency was 36.8%. Conclusion Effective decompression treatment of acute intestinal obstruction could be used as conventional treatment, except for strangulating intestinal obstruction, the majority of patients with intestinal obstruction could receive this therapy widespreadly, especially for them in emergency conditions, inadequate screening, and diagnosis difficulties in unexplained bowel obstruction.