血运重建治疗对伴慢性多血管病变的急性肠系膜缺血导致的短肠综合征患者肠康复治疗效果的影响

Impact of revascularization therapy on intestinal rehabilitation therapy in patients with short bowel syndrome caused by acute mesenteric ischemia with chronic multivessel lesions

目的探索伴慢性多血管病变的急性肠系膜缺血(acute mesenteric ischemia,AMI)导致的短肠综合征(short bowel syndrome,SBS)患者在肠康复治疗(intestinal rehabilitation therapy,IRT)前接受血运重建治疗能否优化IRT的疗效。方法回顾性分析2012年1月至2023年10月期间在中国人民解放军东部战区总医院诊断由伴慢性多血管病变的AMI导致SBS并接受IRT的住院患者18例的临床资料。结果在IRT后,血运重建组的四肢骨骼肌指数和握力的增加量显著高于对照组,分别为[(0.28±0.26)kg/m^(2)比(0.02±0.21)kg/m^(2),P=0.033]和[(0.97±0.33)kg比(0.48±0.34)kg,P=0.007]。同样,血运重建组肠内营养(EN)摄入量的增加量显著高于对照组[(572.5±93.6)ml/d比(375.2±176.3)ml/d,P=0.012],并伴随着肠道氮吸收率更高的提升[(25.06±14.06)%比(13.84±4.62)%,P=0.034]和肠道症状评定量表评分更大幅度的降低[(-15.88±3.94)分比(-6.33±5.13)分,P=0.030],且两组EN制剂类型的组成在IRT后也有显著差异(P=0.046)。此外,血运重建组出院时的简明健康量表(SF-36)在躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、精神健康(MH)等五项指标的得分上显著高于对照组(P<0.05)。结论由伴慢性多血管病变的AMI导致SBS的患者接受血运重建治疗不能使其在IRT中获得体重和血液学营养指标上更高的增长,但有利于患者改善肌肉功能、改善EN吸收、提高摆脱肠外营养的机会、缓解胃肠道症状并提高生活质量。

Objective To investigate whether intestinal rehabilitation therapy(IRT)could optimize the effectiveness of IRT in patients with short bowel syndrome(SBS)caused by acute mesenteric ischemia(AMI)with chronic multivessel lesions.Methods Clinical data of 18 hospitalized patients diagnosed with AMI leading to SBS and undergoing IRT at the Eastern Theater General Hospital of the People's Liberation Army from Jan 2012 to Oct 2023 was retrospectively analyzed.Result Following IRT,the revascularization group showed significantly greater increases in ASMI and grip strength compared to the control group[(0.28±0.26)kg/m^(2)vs.(0.02±0.21)kg/m^(2),P=0.033,and(0.97±0.33)kg vs.(0.48±0.34)kg,P=0.007,respectively].Similarly,the increase in EN intake was significantly higher in the revascularization group compared to the control group[(572.5±93.6)ml/d vs.(375.2±176.3)ml/d,P=0.012],accompanied by a greater improvement in intestinal nitrogen absorption rate[(25.06±14.06)%vs.(13.84±4.62)%,P=0.034]and a more substantial decrease in GSRS scores[(-15.88±3.94)vs.(-6.33±5.13),P=0.030].Moreover,there were significant differences in the composition of EN formulations between the two groups after IRT(P=0.046).Additionally,SF-36 scores at discharge were significantly higher in the revascularization group than that in the control group for five indicators including BP,GH,VT,SF,and MH(P<0.05).Conclusions For patients with SBS resulting from AMI by chronic multivessel lesions,revascularization therapy may not leading to higher growth in weight and hematological nutritional indicators during IRT,but it is beneficial for improving muscle function,improving EN absorption,increasing the likelihood of PN independence,relieving gastrointestinal symptoms,and enhancing overall quality of life.