空肠造瘘与鼻饲营养在胃大部切除术后肠内营养应用中的比较

Effect comparison between jejunostomy and nasojejunal feeding tube in patients after subtotal gastrectomy

目的对比胃大部切除术后空肠造瘘与鼻饲营养2种肠内营养方式的临床疗效。方法选择新疆喀什地区第一人民医院2010年7月—2013年3月收治的130例行胃大部切除术的患者。其中采用鼻饲营养管进行术后肠内营养100例(鼻饲营养组),采用空肠造瘘管进行术后肠内营养30例(空肠造瘘组)。比较两组术后呼吸道、消化道症状及营养管相关并发症之间的差异。结果鼻饲营养组咳嗽、咳痰、咽部不适、腹胀腹痛、恶心呕吐及营养管堵塞发生率均高于空肠造瘘组,差异有统计学意义(P<0.05)。两组肺部感染、发热寒战、反流、肠瘘、脱管发生率差异无统计学意义(P>0.05)。鼻饲营养组肛门排气时间(46.5±9.6)h、营养管留置时间(12.0±3.7)d,空肠造瘘组肛门排气时间和营养管留置时间分别为(34.6±7.4)h、(21.0±5.8)d,两组比较差异均有统计学意义(P<0.05)。结论胃大部切除术中应用空肠造瘘管进行术后肠内营养较留置鼻饲营养管效果好,患者痛苦小,胃肠道功能恢复速度快,并发症少,是一种安全可靠的营养方式。

Objective To compare the clinical efficacy of jejunostomy and conventional nasojejunal feeding tube in patients after subtotal gastrectomy.Methods The clinical data of 130 patients received subtotal gastrectomy between July 2010 and March 2013 were retrospectively analyzed.100 administrated nasojeju-nal feeding tube（Group nasojejunal）while 30 jejununostomy（Group jejununostomy）.Complications of the respiratory system,gastrointestinal system and those relating to the tube were compared between two groups.Results Group nasoj ej unal showed a higher rate of postoperative complications including cough and sputum spiting,throat discomfort,abdominal pain and distention,nausea and vomiting,tube occlu-sion （P 〈0.05）.With regard to complications including pneumonia,fever and chill,food reflux,tube dis-location,no statistical significance were observed （P 〉0.05）.The time to flatus and length of tube main-tenance in Group nasojejunal were （46.5±9.6）h and （12.0±3.7）d,whereas they were （34.6±7.4）h and （21.0±5.8）d in Group jejununostomy,respectively,and statistical significance between groups were ob-served.Conclusion Jejunostomy was a rational,safe and effective choice for patients administrated subtotal gastrectomy,which showed less pain,quicker gastrointestinal recovery and lower postoperative complications.