主动脉瓣置换术后患者腹胀原因分析及不同减压方法的疗效比较

The analysis of the cause of abdominal distension in patients after aortic valve replacement and the comparison of the effect of different gastrointestinal decompression methods

目的分析主动脉瓣置换术后患者出现腹胀的原因，比较不同减压方法在主动脉瓣置换术后中重度腹胀患者中的疗效。方法①选取2015年01月至2017年01月期间在我科行主动脉瓣置换术的患者，多因素Logistic regression分析腹胀的危险因素。②上述研究对象中术后出现中重度腹胀并需要胃肠减压的患者，随机分为2组，分别选用不同的减压方法：A组经鼻置入小肠减压管，B组经鼻置入普通胃管。比较2组患者腹胀缓解有效率以及缓解时间。结果①498例主动脉瓣置换术后患者出现腹胀132例，发生率为26.5%。多因素Logistic regression分析显示术后持续镇静/肌松时间≥72h是腹胀的独立危险因素。② A组52例患者腹胀缓解41例，缓解有效率为78.8%，缓解时间为46.9±18.6h；B组51例患者腹胀缓解30例，缓解有效率为58.8%，缓解时间为55.2±21.4h。A组腹胀缓解有效率明显高于B组，且缓解时间明显短于B组，差异有统计学意义。结论主动脉瓣置换术后患者持续镇静/肌松时间≥72h是腹胀的独立危险因素。小肠减压管在胃肠减压方面较普通胃管疗效更为显著，心脏术后患者出现腹胀需要胃肠减压时，可优先考虑使用。

Objectives To analyze the cause of abdominal distension in patients after aortic valve replacement and to compare the effect of different gastrointestinal decompression methods. Methods ①The clinical data of patients after aortic valve replacement from Jan 2015 to Jan 2017 were collected and analyzed to find the cause of abdominal distension by Multivariate logistic regression. ②The patients with moderate or severe abdominal distension from the first study section, who needed gastrointestinal decompression, were chosen and randomly divided into 2 groups according to different gastrointestinal decompression methods. Patients in the A group were given the small intestine decompression tube, and patients in the B group were given the stomach tube. The effect and time of abdominal distension relief were compared between 2 groups. Results ①There were 132 patients with abdominal distension after aortic valve replacement（132/498,26.5%）. Multivariate logistic regression shows the continuous time of sedatives/ muscle relaxants ≥72h was the independent risk factor for abdominal distension. ②The abdominal distension relief rate was 78.8%（41/52） and the relief time was 46.9±18.6h in the A group. The abdominal distension relief rate was 58.8%（30/51） and the relief time was 55.2±21.4h in the B group. There was significant difference on the relief rate and time between 2 groups, and the A group was better. Conclusions The continuous time of sedatives/ muscle relaxants ≥72h is the independent risk factor for abdominal distension in patients after aortic valve replacement. The small intestine decompression tube is better than the stomach tube for patients who need gastrointestinal decompression after aortic valve replacement.