早期肠内营养、服用多潘立酮、中药灌肠等综合干预措施对肝胆患者外科术后胃肠功能恢复的治疗方法及效果

Comprehensive intervention to promote recovery of gastrointestinal function in patients after hepatobiliary surgery

目的:比较分析肝胆患者外科手术后胃肠功能恢复的治疗方法及效果.方法:收集2013-01/2014-01水矿集团总医院外科收治的84例肝胆外科手术治疗患者临床资料,遵循随机原则,将患者分为研究组与对照组,每组例数均为42.研究组患者实施术后早期肠内营养、多潘立酮治疗、中药灌肠等手术期治疗方法,对照组患者采取补液、营养支持等常规治疗措施,比较两组患者术后肠鸣音恢复时间、首次进食时间、肛门排气时间、排便时间、治疗前后血清白蛋白(serum albumin,SAlb)、前白蛋白(prealbumin,PA)、预后营养指数(prognostic nutritional index,PNI)等指标变化情况以及术后6 d胆囊窝、肝下积液情况.结果:研究组患者肠鸣音恢复时间、首次进食时间、肛门排气时间、排便时间明显短于对照组(29.85 h±8.85 h vs 32.67 h±9.67 h,30.01 h±6.78 h vs 35.14 h±10.83 h,40.95 h±7.85 h vs 49.84 h±15.79 h,41.35 h±12.56h vs 53.86 h±1.35 h),差异具有统计学意义(P<0.05);研究组患者治疗后SAlb、PA、PNI水平均显著升高,与治疗前比较(40.85 g/L±3.85 g/L vs 35.83 g/L±2.84 g/L,4.00 g/dL±1.35 g/dL vs 2.85 g/dL±0.75 g/dL,46.88±5.78 vs 42.15±8.83),差异具有统计学意义(P<0.05);研究组患者治疗后SAlb、PA、PNI水平均显著高于对照组(40.85 g/L±3.85 g/L vs 33.32 g/L±2.45 g/L,4.00 g/dL±1.35 g/dL vs 1.85 g/dL±0.71 g/dL,46.88±5.78 vs 40.81±5.76),差异具有统计学意义(P<0.05);研究组患者胆囊窝及肝下无积液率显著高于对照组(69.05%vs 40.48%),积液长径<2 cm率、积液长径>2 cm率均显著低于对照组(9.52%vs 26.19%、21.43%vs 33.33%),差异有统计学意义(P<0.05).结论:将早期肠内营养、服用多潘立酮、中药灌肠等综合干预措施应用于肝胆患者外科围手术期间,有利于缩短病情恢复时间,减少胆囊窝及肝下积液,促进术后胃肠功能恢复,值得临床推广.

AIM： To assess the clinical effects of comprehensive intervention in promoting the recovery of gastrointestinal function in patients after hepatobiliary surgery.METHODS： Eighty-four patients after hepatobiliary surgery were randomly divided into either a study group（42 cases） or a control group（42 cases）. The study group was treated by early enteral nutrition, domperidone, and Chinese medicine enema, and the control group was treated by fluid infusion and nutrition support. The times to recovery bowel sounds, first meal, anus exhaust, and defecation, serum albumin（SAlb）, prealbumin（PA）, prognostic nutritional index（PNI）, as well as the rate of gallbladder fossaand subhepatic fluid formation on day 6 were compared for the two groups.RESULTS： The times to recovery bowel sounds, firs meal, anus exhaust, and defecation for the study group were significantly lower than those for the control group（29.85 h ± 8.85 h vs 32.67 h ± 9.67 h, 30.01 h ± 6.78 h vs 35.14 h ± 10.83 h, 40.95 h ± 7.85 h vs 49.84 h ± 15.79 h, 41.35 h ± 12.56 h vs 53.86 h ± 1.35 h, P 0.05）. The levels of SAlb, PA, and PNI for the study group post treatment were significantly higher than the values prior treatment（40.85 g/L ± 3.85 g/L vs 35.83 g/L ± 2.84 g/L, 4.00 g/dL ± 1.35 g/dL vs 2.85 g/dL ± 0.75 g/dL, 46.88 ± 5.78 vs 42.15 ± 8.83, P 0.05）, and than those for the control group（40.85 g/L ± 3.85 g/L vs 33.32 g/L ± 2.45 g/L, 4.00 g/dL ± 1.35 g/dL vs 1.85 g/dL ± 0.71 g/dL, 46.88 ± 5.78 vs 40.81 ± 5.76, P 0.05）. The rate of no gallbladder fossa and subhepatic fluid formation on day 6 for the study group was significantly higher than that for the control group（69.05% vs 40.48%, P 0.05）. The rates of fluid formation with a diameter 2 cm and a diameter 2 cm for the study group were significantly lower than those for the control group（9.52% vs 26.19%, 21.43% vs 33.33%, P 0.05）.CONCLUSION： Comprehensive intervention by early enteral nutrition, domperidone, and Chinese medicine enema can shorten the time to gastrointestinal functional recovery and reduce the occurrence of gallbladder fossa and subhepatic fluid formation in patients after hepatobiliary surgery.