生长抑素联合肠梗阻导管治疗粘连性肠梗阻

Somatostatin combined ileus tube in the treatment of adhesive bowel obstruction

目的 探讨生长抑素联合肠梗阻导管在粘连性肠梗阻非手术治疗中的应用价值.方法 将91例粘连性肠梗阻患者按入院顺序随机分为A组（生长抑素＋肠梗阻导管组）,B组（生长抑素＋鼻胃管减压组）,C组（肠梗阻导管组）和D组（鼻胃管组）.常规治疗包括禁食、纠正水电解质和酸碱平衡紊乱,全胃肠外营养以及应用抗生素.A组在常规治疗基础上应用生长抑素类似物（善宁）0.6 mg加入0.9％氯化钠溶液500 ml持续静脉滴注,同时联合置入肠梗阻导管取代普通鼻胃管行肠内减压.观察和比较4组治疗前后临床症状及体征改善情况、胃肠减压量、自主排气、排便时间和中转手术率.数据分别采用方差分析和x2检验进行分析.结果 各组平均腹痛和腹胀的缓解时间分别为3.6±1.5,5.3±1.8,5.8±1.7和8.4±2.2d （F=28.715,P=0.000）；恢复排气、排便时间分别为4.5±1.9,5.7±1.4,6.0±1.1和7.8±1.7 d（F=23.857,P=0.000）；A组临床症状明显改善.平均胃肠减压量分别为A组：632±102 ml/d；B组：410±86 ml/d,C组：1020±148 ml/d和D组590±97 ml/d.在C组,患者的胃肠减压量明显增加（F值分别为17.367,16.347,P=0.000）,而A组则明显减少（F值分别为11.687,10.399,P=0.000）.4组中转手术率分别为0（0/22）,10％ （2/19）,9％（ 3/23）和22％ （6/27）,A组中转手术率明显低于D组（x2=5.571,P=0.018）.结论在常规治疗的基础上,应用生长抑素静脉持续泵入联合肠梗阻导管治疗,可加速改善粘连性肠梗阻患者的临床症状,并且提高保守治疗的成功率.

Objective To evaluate the efficacy and safety of somatostatin and ileus tube for adhesive bowel obstruction.Methods From January 2008 to February 2010,ninety-one patients diagnosed with adhesive bowel obstruction were enrolled in the study.Patients were randomly divided into four groups：somatostatin ＋ ileus tube group （ group A,n =22 ）,somatostatin ＋ nasogastric tube group （group B,n=19）,ileus tube group （group C,n=23）,and nasogastric tube group （group D,n =27）.All cases received conventional treatment,including fasting,maintaining electrolyte and acid-base balance,enteral and parenteral nutrition support and antibiotics; Groups A and B received somatostatin 0.6 mg/day,groups B and D received nasogastric tube decompression.ANOVA analysis and x2 test were used to compare the variables.Results Group A had a quick recovery of flatus and stool compared with group D,[ （4.5 ±1.9） vs.（7.8 ± 1.7） d] （F =28.715,P =0.000）.Abdominal pain and abdominal distension recovered faster [ （3.6 ± 1.5） vs.（8.4 ± 2.2） day ] in group A compared with group D （ F =23.857,P =0.000）.Less amount of gastric drainage were observed in somatostatin-treatment groups [ group A vs.C：（632 ±102） ml/d vs.（1020±148） ml/d; group B vs.D：（410±86） ml/d vs.（590±97） ml/d] （F=11.687,P =0.000;F=10.399,P =0.000）.The rate of laparotomy in group A was O,which was significantly less than the 22% in group D （ x2 =5.571,P =0.018 ）.Conclusions The high improvement rate in abdominal symptoms suggested the efficacy of somatostatin and ileus tube in patients with small bowel obstruction.The application of somatostatin combined with ileus tube improves the symptoms of adhesive intestinal obstruction and decreases the rate of laparotomy.