经鼻肠梗阻导管联合泛影葡胺治疗腹部术后急性粘连性小肠梗阻的临床分析

摘要

Objective To investigate the effect of long nasointestinal tube (LT) with gastrografin in the treatment of postoperative adhesive small bowel obstruction.Methods Retrospective analysis was performed on 206 cases of elderly patients with adhesive small intestinal obstruction, who were admitted in the Second Affiliated Hospital of Dalian Medical University from September 2013 to September 2016.The patients were divided into 5 groups according to different treatment methods.(1)Stomach tube group:traditional nasogastric decompression therapy;(2)Stomach tube with gastrografin: traditional nasogastric decompression with gastrografintherapy;(3)LT group: Only LT therapy;(4)Gastrografin group:Only gastrografin therapy;and (5)LT with lgastrografin group:LT with gastrografin therapy.Forgroups usinggastrografin,60-100 mL 76% gastrografin solution weretaken orally or infusedthrough nasogastric tube, the tube was then clampedfor 2 hours.Clinical symptoms were observed.Severityor remission of obstruction was evaluated through abdominal X-ray and spiral computed tomography.The abdominal pain relief time, the first defecation time,length of stay and effective rate were compared among 5 groups.Results LT was placed successfully in all patients.Compared to other groups, the group of LT with gastrografinwas superior in the aspects of abdominal pain, relief time, the first defecation time,effective rate and length of stay in hospital(P<0.05).Conclusion The LT with gastrografin therapy can become a new method for the treatment of acute intestinal obstruction, and is worth clinical promotion.%目的 探讨肠梗阻导管联合泛影葡胺对腹部术后急性粘连性小肠梗阻的治疗效果.方法 收集2013年9月至2016年9月206例急性粘连性小肠梗阻患者的临床资料,根据治疗方法不同分为5组.(1)胃管组(55例):为传统的经鼻胃管减压治疗;(2)胃管+泛影葡胺组(60例):为传统经鼻胃肠减压联合泛影葡胺治疗;(3)导管组(38例):应用经鼻型肠梗阻导管治疗;(4)泛影葡胺组(23例):为单纯口服泛影葡胺治疗.(5)导管+泛影葡胺组(30例):应用经鼻型肠梗阻导管联合泛影葡胺治疗.应用泛影葡胺组,口服或经鼻胃管以及肠梗阻导管注入60~100 mL 76%的泛影葡胺注射液,注药后夹管2 h,观察临床症状,并结合腹部X线摄片、螺旋CT动态观察梗阻加重和缓解情况.比较5组的腹部疼痛缓解时间、给予治疗后首次排便时间、住院时间以及治疗有效率.结果 所有患者均按要求置管成功.经鼻型肠梗阻导管联合泛影葡胺组患者腹痛缓解时间、首次排便时间、住院时间及有效率等情况明显优于传统鼻胃管、传统鼻胃管联合泛影葡胺、单纯泛影葡胺以及单纯肠梗阻导管组(P<0.05).结论 肠梗阻导管联合泛影葡胺可成为治疗急性肠梗阻的新手段、新方法,值得临床推广.