烧伤后急性结肠假性梗阻临床分析

Acute colonic pseudo-obstruction in burn patients clinic analysis

目的 报道烧伤后并发急性结肠假性梗阻 (ACPO)的发生原因、临床表现和治疗措施。方法 对 3例严重烧伤后并发急性结肠假性梗阻病例进行回顾性分析 ,并结合相关文献进行讨论。结果 ( 1) 3例中 2例死亡 ;( 2 )患者的发病原因不清楚 ;( 3)烧伤面积大 ,程度深 ,属于特重度烧伤 ;( 4 )以进行性腹胀为特点 ,出现类似机械性肠梗阻症状和体征 ,但可有肛门排气和排便 ,腹痛通常不显著 ;( 5 )腹部平片以结肠过度充气膨胀为主 ;( 6 )纤维结肠镜肠道减压或剖腹肠道减压是有效的治疗和诊断方法。结论 烧伤后并发急性结肠假性梗阻虽然少见 ,但危险性大 ,死亡率高。当严重烧伤患者的病程中出现不好解释的肠梗阻症状时 。

Objective To discuss the causes, clinical characters and management of acute colonic pseudo-obstruction (APCO) in burned patients.Methods An retrospective study was made on three cases of seriously burned patients combined with acute colonic pesudo-obstruction and the related literature was also reviewed.Results (1)Two of the three patients died.(2)The causes of ACPO remains unclear.(3)The burn injury of the patients was extensive in the area and deep in the depth.All of them were special deep burn.(4)Progressive abdominal distention was the common character, which was similar to mechanical intestinal obstruction, but defecation and exhaust could be found in these patients,and abdominal pain was uncommon.(5)X-ray showed overexpansion and large dilated loops of colon.(6)Intestinal tract decompression through fibro- colonoscope or exploratory laparotomy was an effective method.Conclusion Though acute colonic pseudo-obstruction in burned patients was seldom found in clinic, it was very dangerous,and the mortality was high.It was precautionary that APCO maybe occurred when unexplained intestinal obstruction symptoms appeared in severe burn case.