生长抑素在不同类型肠梗阻非手术治疗中的应用

Application of somatostatin in nonoperative treatment of different kinds of intestinal obstruction

目的探讨生长抑素在不同类型肠梗阻非手术治疗中的疗效.方法 回顾性分析338例肠梗阻患者的临床资料,按肠梗阻病因分为粘连性肠梗阻、炎症性肠梗阻、肿瘤性肠梗阻.采用非手术方法治疗,对照组给予禁食、胃肠减压、洗肠、纠正水电解质、酸碱平衡紊乱和应用抗生素等常规治疗方案,治疗组在常规治疗基础上加用生长抑素6 mg ＋0.9％氯化钠注射液120 mL,持续24 h微量泵注入.比较两组疗效.结果 治疗组腹胀腹痛缓解率为80.2％,明显高于对照组的62.3％（Х^2=250.446,P＜0.05）;治疗组恶心呕吐缓解率、肛门有排气排便占有率分别为84.1％、64.7％,对照组分别为87.7％、61.6％,两组差异均无统计学意义（Х^2=0.902、0.349,均P＞0.05）;治疗后治疗组胃肠减压量为（328±229）mL/d,明显低于对照组的（694±381）mL/d（t =2.883,P＜0.05）;治疗组总有效率为95.7％,对照组为94.0％,两组差异无统计学意义（Х^2=0.007,P＞0.05）.除外肿瘤性肠梗阻患者,两组病例中转手术率为：治疗组2.4％,对照组2.8％,差异无统计学意义（Х^2=0.051,P＞0.05）.除外肿瘤性肠梗阻及中转手术的患者,住院时间分别为：治疗组（10.6±4.9）d,对照组（15.3±4.1）d,差异有统计学意义（t=2.528,P＜0.05）;治疗组粘连性和炎症性肠梗阻的腹痛、腹胀、促进肛门排气排便、24h胃肠减压量改善情况差异均无统计学意义（Х^2=0.008、0.230,t =0.117,均P＞0.05）;肿瘤性肠梗阻症状缓解不明显.结论 生长抑素能迅速缓解不同类型肠梗阻症状、体征,明显缩短住院时间;但未能减少中转手术率;如果忽略治疗时间长短,生长抑素未能明显提高肠梗阻治疗有效率.粘连性和炎症性肠梗阻的疗效相当,但改善肿瘤性肠梗阻症状的疗效稍差,且不彻底、易反复.

Objective To investigate the therapeutical effects of somatostatin in nonoperative treatment of different kinds of intestinal obstruction.Methods 338 cases of intestinal obstruction accepted by our hospital were retrospectively analyzed,which were divided into adhesive intestinal obstruction,inflammatory intestinal obstruction and malignant tumor intestinal obstruction.With nonoperative treatment,the control group were treated with routine therapy,including fasting,gastrointestinal decompression,intestinal lavage,intravenous replacement of fluid and electrolytes,disturbance of acid-base balance and the application of antibiotics.As for the treatment group,they were pumped with 6mg of somatostatin and 120mL physiological saline as well as routine therapy for 24 hours.The effects of the two groups were compared.Results The remission rate of abdominal distension and abdominal pains was 80.2% in the treatment group and 62.3% in the control group,the difference was statistical significance （Х^2 =250.446,P 〈 0.05）.The remission rate of nausea and vomiting was 84.1% in the treatment group and 87.7% in the control group.The passage of gas and defecation by anus was 64.7 % in the treatment group and 61.6% in the control group,there was no clear difference between the two groups （Х^2 =0.902,0.349,all P 〉 0.05）.The gastrointestinal decompression amounts reduced clearly,the treatment group was （328 ±229） mL/d and （694 ± 381） mL/d in the control group,there was significant difference （t =2.883,P 〈 0.05）.After nonoperative conservative treatment,the effects between the two groups were as follows：the effective percentage was 95.7% in the treatment group and 94.0% in the control group,there was no significant difference（Х^2 =0.007,P 〉 0.05）.Except intestinal obstruction patients with external tumors,the rates of transferring to operation was 2.4 % in the treatment group and 2.8 % in the control group,there was no statistical significance（Х^2 =0.051,P 〉 0.05）.And except patients of intestinal obstruction with external tumors and transferring to operation,the hospital stay was （10.6 ±4.9） d in the treatment group and （15.3 ± 4.1） d in the control group,the difference was significant （t =2.528,P 〈 0.05）.As for the treatment group with somatostatin,there was no significant difference（Х^2 =0.008,0.230,t =0.117,all P 〉 0.05） in abdominal distension and abdominal pains of adhesive and inflammatory intestinal obstruction,promoting the passage of gas and defecation by anus,the improvement of gastrointestinal decompression amounts in 24 hours.The improvement of tumor intestinal obstruction was worse.Conclusion Somatostatin treatment can help to ease the symptoms and physical signs of different kinds of intestinal obstruction rapidly and cut down hospital stay clearly,but can not reduce the rates of transferring to operation.If the time of treatment is ignored,it can not improve the therapeutical effective percentage of intestinal obstruction obviously.There is no significant difference for the application of adhesive and inflammatory intestinal obstruction.However,it can not completely and well improve the symptoms of tumor intestinal obstruction and the symptoms can recrudesce easily.