摘要
目的 总结长期禁食的肠外瘘病人在使用肠内营养 (EN)早期出现并发症的特点与规律 ,并探讨其治疗方法。方法 连续收集 2 0 0 1年 4月至 2 0 0 2年 7月治愈的肠外瘘病人 10 0例。收集肠内营养开始前的禁食时间 ;肠内营养实施前、实施后 1、3、5、10、15天肝功、生化和营养指标。收集大便次数、体温、心率和呼吸次数并进行全身炎症反应综合征 (SIRS)评分。所有病人均选用短肽类制剂。结果 10 0例肠外瘘病人均为成功治愈病例 ,其中择期手术 5 6例 ,早期手术 15例 ,自行愈合 2 9例。AKP在EN前为 (181 5± 12 7 5 )U ,在EN后第 3天显著升高为 (2 4 3 0± 12 1 6 ) ;γ -GT在EN前为 (118 4± 94 2 )U ,EN后第 1和第 3天显著升高 ,分别为 (14 9 6±92 1)U ,(177 2± 10 9 9)U。以后各指标渐降低。出现淤胆性胆囊炎 3例。大便次数超过 3次的在肠内营养实施后第 1、3、5、10和 15天分别为 31例 ,2 6例 ,12例 ,13例和 7例。SIRS评分在EN后第 1天 (1 0 5± 1 0 8)和第3天 (0 96± 1 11)均显著高于EN前 (0 72± 0 84 ) ;在EN第 5天逐渐降低 (0 83± 0 91) ;SIRS评分在EN第 10天 (0 4 9± 0 73)和第 15天 (0 32± 0 6 0 )显著低于EN前。结论 肠内营养再灌食综合征的出现与胃肠道长期缺乏腔内营养所致?
Objective\ To study the features and the management of early complications in restarting enteral feeding(EN)in gastrointestinal fistula patients.Methods\ One hundred cured gastrointestinal fistula patients from Apr.2001 to July 2002 were studied.The fasting time,the liver function test,biochemical laboratory and nutritional parameters were collected before and 1,3,5,10 and 15 days after EN.Body temperature,stool frequency,heart rate,respiratory rate and white blood cell count were collected at the same time as well for the systemic inflammatory reaction syndrome(SIRS)score.Predigested peptide liquid diet was used in all patients.Results\ Among 100 gastrointestinal fistula patients,56 patients were cured by late enteric fistula resection,15 patients were cured by early enteric fistula resection and 29 patients were cured by spontaneous closure therapy.Both AKP and r-GT increased significantly after 3 days of EN and decreased gradually.Three patients developed cholecystitis due to cholestasis.The patients with more than 3 times of stool frequency were 31,26,12,13 and 7 on the 1st,3rd,5th,10th and 15th day after EN.SIRS score was significantly high in the first day (1.05±1.08) and third day(0.96±1.11)after EN compared with the day before EN (0.72±0.84).SIRS sscre decreased gradually after 5 days of EN (0.83±0.91),and it was significantly lower after 10 days(0.49±0.73)and 5 days (0.32±0.60) of EN than it was before EN.Conclusion\ The development of enteral feeding restarting syndrome is related to intestinal mucosa atrophy caused by long term gastrointestinal nutrition absence,mucosa edema caused by hypoproteinemia and intestinal dysbacteriosis.Endotoxin translocation due to damage of intestinal barrier function may be the main cause of SIRS.Frequent try of enteral nutrition was the best way to treat these complications and most of these complications can resolve spontaneously with continuing EN.
出处
《中国实用外科杂志》
CSCD
北大核心
2003年第2期86-89,共4页
Chinese Journal of Practical Surgery
