摘要
目的:观察胃肠手术患者胃管不同处理策略对术后并发症风险及胃肠恢复的影响。方法:将我院148例胃肠手术患者抽签随机分为A、B、C、D 4组,每组37例,所有患者均基于快速康复外科理念实施围术期处理,A组不常规留置胃管,B组常规留置胃管并于全麻气管导管拔管前5 min拔除,C组常规留置胃管并于麻醉完全清醒后6 h拔除,D组常规留置胃管并于麻醉完全清醒后12 h拔除。比较4组患者术后首次排气时间、排便时间及肠鸣音恢复时间,以放射免疫法检测4组不同时间血管活性肠肽(VIP)、胃动素(MTL)、胰高血糖素(GLU)表达情况,对4组术后并发症发生率进行分组记录并比较。结果 :4组排气时间比较差异无统计学意义(P>0.05),首次排便时间、肠鸣音恢复时间A组显著较短(P<0.05);4组术前、术后1 d VIP、MTL、GLU比较差异无统计学意义(P>0.05),术后3 d A组VIP低于另外3组,随拔管时间延长,VIP呈上升趋势。术后3、7 d MTL水平随拔管时间延长呈现递减趋势,A组水平最高,组间比较差异均有统计学意义(P<0.05)。术后3、7 d GLU水平随拔管时间延长呈现递增趋势,A组水平最低,组间比较差异均有统计学意义(P<0.05);两组咽部不适以A组显著较低,与另3组比较显著较低(P<0.05),其他不适及并发症发生率比较差异无统计学意义(P>0.05)。结论:胃肠手术不留置胃管可使术后胃肠功能恢复受益,可降低不良事件发生率,留置胃管的患者应尽可能缩短置管时间,从而加快患者康复进程,提高术后安全性。
Objective To assess the effect of different clinical interventions for gastric tube in patients undergoing gastrointestinal operations for measuring the risk of postoperative complications and recovery of gastrointestinal tract. Methods A total of 148 patients undergoing gastrointestinal operations were recruited and divided into Group A, B, C and D, with 37 cases in each group. All patients underwent perioperative management based on the concept of rapid rehabilitation surgery. Group A were not indwelled with gastric tube with routine method. Group B were indwelled with gastric tube with routine method and got nasogastric extubation 5 rain before tracheal extubation. Group C were indwelled gastric tube with routine method and got nasogastric extubation 6 h after fully conscious of anesthesia. Group D indwell gastric tube with routine method and got nasogastric extubation 12 h after fully conscious of anesthesia. The parameters including time of the first passing of flatus, defecation and resuming peristaltic sound after operation between the groups were compared. Vasoactive Intestinal Peptide （VIP）, Motilin （MTL） and Glucagon （GLU）before the operation, and at the 1st, 3rd and 7th day after operation were measured by radioimmunoassay. Results Time of the first passing of flatus, defecation and resuming peristaltic sound after operation showed a rising trend from Group A to Group D. The difference in time of the first passing of flatus was not significant （P〉0.05）, time of defecation and resuming peristaltic sound after operation in Group A were significantly shorter （P〈0.05）. There were no statistical differences in VIP, MTL, GLU among the groups before the operation and at the 1st day after operation（P〉0.05）. VIP in Group A at the 3rd day after operation was significantly lower than those in other 3 groups, with the increasing of time for indwelling tubes. VIP showed a rising trend. MTL showed a decreasing trend with the increasing of time for indwelling tubes at 3rd and 7th day after operation. GLU in Group A was the highest （P〈0.05） . GLU showed a rising trend with the increasing of time for indwelling tubes at 3rd and 7th day after operation. GLU in Group A was the lowest （P〈0.05） . The pharyngeal discomforts were least in Group A （P〈0.05） .Pulmonary infection rate showed a rising trend with the increasing of time for indwelling tubes, but the difference was not significant （P〉 0.05）. Nausea and vomiting, anastomotic fistula, intestinal obstruction, abdominal distension in d groups showed no significant differences （P〉0.05）. Conclusion Avoidance of gastric tube in gastrointestinal operations can benefit the postoperative recovery of gastrointestinal tract, reduce pharyngeal discomforts and pulmonary infections. For patients with indwelled gastric tube, the time for indwelling tubes should be shorten, in order to speed up the recovery process and improve the safety of the patients.
作者
樊晓静
Fan Xiao-jing.(Affiliated autonomous region of Xinjiang Medical University, Urumqi, 830000, Chin)
出处
《实用医学杂志》
CAS
北大核心
2016年第18期3060-3063,共4页
The Journal of Practical Medicine
关键词
围术期
胃管
胃肠手术
胃肠功能
Perioperative period
Gastric tube
Gastrointestinal surgery
Gastrointestinal function
