短肠综合征的康复治疗

Rehabilitation Therapy for Short Bowel Syndrome

目的 :总结 2 7例短肠综合征病人康复治疗的经验 ,介绍短肠康复治疗的具体方法 ,探讨改善短肠病人营养状况、促进肠功能代偿的措施。 方法 :1997年 1月～ 2 0 0 0年 7月间共 2 7例短肠病人接受了 2 9次康复治疗 ,病人平均年龄 (38.5± 19.3)岁。剩余小肠长度范围 15～ 80 cm,平均 (46 .8± 2 3.4) cm,15例有回盲瓣。从肠切除至接受康复治疗的平均时间为 (86± 10 5 )天。 结果 :治疗后病人的营养状况明显改善 ,肠道吸收功能有所增强。随访时间超过 1年者 2 1例 ,有 18例完全脱离肠外营养 ;随访超过 2年者 8例 ,4例完全脱离肠外营养。 结论 :短肠康复治疗能够有效地改善短肠病人的营养状况 ,并能促进肠功能代偿 ,治疗效果与残留小肠长度、治疗开始的时间和病人年龄有关 ,及早进行康复治疗能够促进肠功能代偿 ,减少病人对肠外营养的依赖。

Objectives:Rehabilitation therapy was applied to 27 patients with short bowel syndrome, and the results were satisfactory. The study was to introduce the method, and summarize the experiences of the treatment and to discuss factors affecting intestinal adaptation and the patients outcome. Methods: Rehabilitation therapy for short bowel syndrome includes enteral or parenteral nutrition, glutamine, recombinant human growth hormone, rehabilitation diet, and measures to relieve short bowel symptoms and to prevent and treat complications related to short bowel syndrome. From January 1997 to July 2000, 27 patients with short bowel syndrome had received the treatment.The average age of the patients was 38.5±19.3 years old, the length of residue small intestine ranged from 15 to 80 cm( average 46.8±23.4 cm), ileocecal valve was preserved in 15 cases, and the average time between the onset of short bowel syndrome and the rehabilitation therapy was 86±105 days. Results: After the treatment, the nutritional status of the patients was improved markedly, and intestinal absorptive capacity was improved. Twenty one patients were followed up for more than one year,and 18 patients weaned from TPN.8 patients were followed up for more than 2 years, and 4 patients weaned from TPN. Conclusions: Rehabilitation therapy for short bowel syndrome can improve the patients nutritional status effectively and promote intestinal adaptation. The therapeutic effects were related to the length of the residue small intestine, the patients' age and the duration between massive intestinal resection and the onset of the treatment.Early rehabilitation therapy can promote intestinal adaptation and increase the patients' liability to wean from TPN.