经口泛影葡胺对粘连性小肠不全梗阻疗效的前瞻性研究

A prospective randomized trial of the effect of oral Gastrografin in adhesive,partial small-bowel obstruction.

目的 探讨泛影葡胺在急性粘连性小肠不全性梗阻的治疗作用，并与甘露醇及常规的保守治疗方法作前瞻性研究。方法 对１０９ 例急性粘连性小肠不全梗阻１１７ 例进行分析，随机将病人分成泛影葡胺组３７ 例４１次经胃管注入７６ ％ 泛影葡胺溶液１００ｍｌ，甘露醇组３５ 例３６ 次经胃管注入１０ ％ 甘露醇溶液２００ｍｌ，对照组３７ 例４０ 次一般保守治疗。观察肠梗阻缓解时间，手术及住院时间。结果 平均第一次排便时间Ｇ 组６－３ 小时，Ｍ 组１６－５ 小时，Ｃ组２７－３ 小时（Ｇ：Ｍ，Ｐ ＜ ０－０５ ；Ｂ：Ｃ， Ｐ＜ ０－０２ ；Ｇ：Ｃ， Ｐ ＜ ０－０１） 。Ｇ 组３ 次，Ｍ 组６ 次，Ｃ 组９ 次经治疗无效而手术，差异无统计学意义。各组对治疗有效平均住院时间分别为Ｇ 组２－９ 天，Ｍ 组３－７ 天，Ｃ 组４－５天（Ｇ：Ｃ， Ｐ＜ ０－０１） 。结论 经口泛影葡胺对急性小肠不全性梗阻是一种安全有效的治疗方法，较目前临床上采用的方法，它能明显缩短肠梗阻缓解及住院时间，同时还为早期手术提供线索。

objective The therapeutic effect of oral Gastrografin in acute adhesive,partial small-bowel obstruction(APSBO)was studied in this trial,compared with Mannitol and general conservative treatment.Methods A total of 117 episodes of adhesive partial small-bowel obstruction in 109 patients were divided into three groups randomly;37 cases of Gastrografin(41 episodes,G group)were treated with 100ml of Gastrografin administered through nasogastric tube;35 cases of Mannitol group(36 episodes,M group)were treated with 200ml of 10% Mannitol administered through nasogastric tube;37 cases were treated by conservative methods.Results Mean time of the first stool was 6 3 hours in the G group,16 5 hours in the M Group and 27 3 hours in the C group(G:M,P<0 05;M:C,P<0 02;G:C,P<0 01).Mean hospital stay time for the patients who respond to manage ment was 2 9 days in the G group,3 7 days in the M group and 4 5 days in the C group respectively(G:C P<0 01).3 episodes in the G group,6 episodes in the M group and 9 episodes in the C group who failed to respond to management required operative treatment.This difference did not have satistical significance.Conclustion Orally administered Gastrografin is a safe and effective method for adhesive,partial small-bowel obstruction.Compared with measures taken clinically at present,this method can reduce the time of relief in the obstruction and shorten hospital stay.It is possible that Gastrogrfin provides an early clue as to whether the obstructing episode would respond to management or would require operative therapy.