手术后早期炎性肠梗阻的综合治疗

Combination therapy of early postoperative inflammatory ileus

目的 :探讨对症处理、营养支持、生长抑素及肾上腺皮质激素等药物的综合措施对术后早期炎性肠梗阻(EPII)的治疗作用。 方法 :2 0 0 1年 5～ 12月收治 10例EPII病人 ,在一般对症处理的基础上给予早期肠外营养支持加施他宁及肾上腺皮质激素 ,并逐渐过渡到肠内营养支持 ,观察临床症状改善情况、胃液量、营养支持时间、住院时间、血常规、血生化及营养指标。 结果 :治疗后第 2天病人胃液量即显著减少 (P <0 .0 5 ) ,腹痛、腹胀等症状很快缓解 ,营养指标及肝、肾功能无明显变化 ,肠外营养支持时间平均为 2 1天 ,肠内营养支持平均为 9天 ,平均住院32天 ,所有病人均治愈 ,未行手术治疗。 结论 :EPII是一种特殊类型的肠梗阻 ,采用胃肠减压、维持内稳态、肠内及肠外营养支持、给予生长抑素及肾上腺皮质激素等的综合治疗 ,能明显改善症状、维持病人的营养状况及内环境稳定 ,促进肠功能的恢复 ,有效地治疗EPII。

Objectives: Early postoperative inflammatory ileus(EPII) is a special type of ileus. For its special pathophysiological and clinical characters, EPII is hard to be treated.The combination therapy including total parenteral nutrition(TPN), enteral nutrition(EN), somatostatin and cortin has been used to treat EPII. Methods: From May 2001 to December 2001, 10 EPII patients were treated and the changes of clinical symptoms, serum total protein, albumin, prealbumin and the curative effect were observed. Results: All patients were cured without operation. Two days after treatment, the gastric juice was reduced from (1 377.5±856.8)ml to (484.0±396.3)ml ( P = 0.037 ) but the serum total protein, albumin and prealbumin had no changes. The clinical symptoms subsided quickly. Average TPN time was 21 days and EN time was 9 days. The average time in hospital was 32 days. Conclusions:The combination therapy can obviously alleviate the clinical symptoms, maintain the nutritional status and promote the recovery of intestinal function in EPII patient.