【摘要】 目的 探討強化益生元膳食纖維的腸內(nèi)營養(yǎng)在腹部外科術(shù)后患者中的臨床應(yīng)用?！》椒ā?008年7月-2010年11月30例接受腹部外科中等以上手術(shù)的患者術(shù)前隨機分為研究組和對照組，每組15例。研究組患者于術(shù)后接受腸內(nèi)營養(yǎng)，并予以強化益生元膳食纖維；對照組只接受相同的腸內(nèi)營養(yǎng)支持。觀察指標(biāo)為術(shù)后感染并發(fā)癥、胃腸道并發(fā)癥、住院時間、抗生素治療時間、C反應(yīng)蛋白水平和病死率等?！〗Y(jié)果 研究組術(shù)后住院時間為（10±5） d，對照組為（15±7） d，兩組差異有統(tǒng)計學(xué)意義（t=2.251，P=0.033）；研究組C反應(yīng)蛋白水平為（6.6±3.2） mg/L，對照組為（9.8±2.1） mg/L，兩組差異有統(tǒng)計學(xué)意義（t=3.238，P=0.003）；研究組抗生素治療時間為（5.0±3.5） d，對照組為（6.0±4.8） d，兩組差異無統(tǒng)計學(xué)意義（t=0.652，P=0.520）。兩組均無死亡病例；術(shù)后研究組2例發(fā)生感染并發(fā)癥，對照組3例，兩組感染并發(fā)癥發(fā)生率差異無統(tǒng)計學(xué)意義（P=1.000）。兩組患者均能耐受經(jīng)腸內(nèi)補充營養(yǎng)素?！〗Y(jié)論 與常規(guī)腸內(nèi)營養(yǎng)比較，給予強化益生元膳食纖維的腸內(nèi)營養(yǎng)能減少腹部外科術(shù)后患者的住院時間，降低急性期炎癥反應(yīng)?！続bstract】 Objective To investigate the effect of early enteral supply of prebiotic fiber in patients undergoing major abdominal surgery. Methods Between July 2008 and November 2010, 30 patients undergoing major gastrointestinal surgery were randomized into the study group and the control group before operation with 15 patients in each group. Prebiotic fiber was administered combined with enteral nutrition support for patients in the study group. Patients in the control group only received conventional enteral nutrition without fiber. The main endpoints included the development of bacterial infection, the duration of hospital stay, antibiotic therapy, the serum level of C-reaction protein (CRP), side effects of the enteral nutrition and morbidity. Results Compared with the control group, the median duration of hospital stay was shorter in the study group [(15±7) days in the control group vs. (10±5) days in the study group; t=2.251, Plt;0.05]. The mean level of CRP was also lower in the study group [(6.6±3.2) mg/L] than that in the control group [(9.8±2.1) mg/L] (t=3.238, Plt;0.05). The enteral nutrition and fibers were well tolerated. The incidence of infectious complications (3 cases in the control group vs. 2 cases in the study group) and the median duration of antibiotic therapy [(6.0±4.8) days in the control group vs. (5.0±3.5) days in the study group] were not significantly different between the two groups (t=0.652, Pgt;0.05). No patients died in both the two groups. Conclusion Compared with the conventional enteral nutrition, early enteral supply of prebiotic fiber can reduce the duration of hospital stay and acute phase response.
【摘要】 目的 總結(jié)結(jié)腸自發(fā)性穿孔的病因、診斷和治療方法。 方法 回顧性分析2000年－2010年收治的9例因自發(fā)性結(jié)腸穿孔接受急診剖腹探查手術(shù)患者的臨床資料。 結(jié)果 平均發(fā)病年齡67.6歲（55～84歲），5例有慢性便秘病史；患者均以突發(fā)性腹痛起病，2例得到術(shù)前確診。1例行穿孔修補術(shù)，6例行穿孔修補或穿孔腸段切除加近端結(jié)腸造瘺術(shù)，2例行Hartmann手術(shù)。治愈出院6例，2例切口感染，1例嚴(yán)重感染?！〗Y(jié)論 自發(fā)性結(jié)腸穿孔好發(fā)于老年長期便秘史者，通常預(yù)后不良，且術(shù)后病死率較高。早期發(fā)現(xiàn)和手術(shù)治療、徹底的腹腔內(nèi)沖洗和嚴(yán)密的術(shù)后管理是改善預(yù)后的重要因素。