咀嚼口香糖对脾切断流术后患者胃肠道功能恢复的作用

Effect of chewing gum on recovery of gastrointestinal function after splenectomy and pericardial devascularization

目的探讨咀嚼口香糖对脾切断流术患者术后胃肠功能恢复的疗效,并从神经和体液两方面探索其作用机制.方法选取90例行脾切断流术的患者,采用区组随机化的方法随机分成实验组咀嚼无糖口香糖组和对照组.咀嚼口香糖组从术后4 h开始咀嚼口香糖,于第3次咀嚼口香糖后1 h抽取血液检测胃泌素和去甲肾上腺素水平.对照组则采用术后常规治疗及护理.观察对比2组患者胃泌素、去甲肾上腺素水平,肠鸣音恢复时间、肛门排气、排便时间和平均住院时间,以及恶心、呕吐、腹胀、肠梗阻等术后相关并发症的发生情况.结果观察组和对照组术后肠鸣音恢复时间(33.82 h±1.52 h vs 42.82 h±1.30 h)、首次排气时间(60.63 h±2.78 h vs 67.43 h±2.84 h)、首次排便时间(70.13 h±3.12 h vs 86.39 h±2.43 h)、住院时间(12.46 d±0.71 d vs 15.52 d±0.85 d)比较,前者较后者缩短,差异均有统计学意义(P<0.05).实验组去甲肾上腺素水平显著低于对照组,差异有统计学意义(t=-11.26,P=0.000).而实验组胃泌素水平比较,差异无统计学意义(t=1.801,P=0.075).咀嚼口香糖组腹胀发生率较对照组减少,差异有统计学意义(P=0.024),而术后恶心、呕吐以及肠梗阻发生率较对照组差异均无统计学意义(P>0.05).结论咀嚼口香糖可促进脾切断流术术后患者胃肠功能恢复,缩短住院时间,且方法简便安全,可作为脾切断流术后胃肠功能恢复的综合治疗手段之一,其具体的作用机制可能与血儿茶酚胺的水平相关.

AIM To investigate the effect of chewing gum on the recovery of gastrointestinal function after splenectomy and pericardial devascularization and its mechanism of action with regard to neural and humoral factors.METHODS This study was a randomized controlled trial conducted in 90 patients who underwent splenectomy and pericardial devascularization.The patients were randomly divided into either group A（chewing gum group） or group B（control group）. Patients of group A started chewing gum from 4 h after the operation,while the control group received conventional therapy and nursing after operation. Blood samples were taken immediately after the 3rd gum-chewing for detecting the levels of gastrin and norepinephrine. The levels of gastrin and norepinephrine, time to first bowel motion,flatus, and defecation, length of hospital stay, and bowel-related complications were compared between the two groups.RESULTS The mean time to bowel motion（33.82 h ±1.52 h vs 42.82 h ± 1.30 h）, mean time to flatus（60.63 h ± 2.78 h vs 67.43 h ± 2.84 h）, mean time to defecation（70.13 h ± 3.12 h vs 86.39 h± 2.43 h）, and mean length of hospital stay（12.46 d ± 0.71 d vs 15.52 d ± 0.85 d） were all significantly reduced in patients who chewed gum compared with control patients（P 〈0.05）. There was a significant difference in nompinephrine level between the two groups（t =-11.26, P = 0.000）, although blood level of gastrin showed no significant difference between the two groups（t = 1.801, P =0.075）. Fewer participants assigned to receive chewing gum developed abdominal distention compared with control patients（χ-2 = 5.075, P =0.024）. There were no significant differences in the rates of postoperative nausea, emesis and ileus between the two groups（P〉 0.05）.CONCLUSION Chewing gum decreases the time to recover gastrointestinal function and shorten the duration of hospitalization. It can be used as a component of comprehensive therapy for a gastrointestinal function recovery program after splenectomy and pericardial evascularization.The mechanism may be related to altering the level of blood eatecholamine.