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分析
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摘要
目的探究胃管不同处理策略对于胃肠患者术后并发症及胃肠恢复的影响。方法选取本院2016年1月至2018年6月收治的100例需手术的胃肠患者,随机分为4组,每组25例,Ⅰ组常规留置胃管并于全麻气管导管拔管前5 min拔除、Ⅱ组常规留置胃管并于麻醉完全清醒后6 h拔除、Ⅲ组常规留置胃管并于麻醉完全清醒后12 h拔除、Ⅳ组不采取常规留置胃管。记录并比较4组患者术后并发症及胃肠功能恢复情况(首次排气时间、排便时间及肠鸣音恢复时间),检测并比较不同时间点血管活性肠肽(Vasoactive intestinal peptide,VIP)、胃动素(Motilin,MTL)、胰高血糖素(Glucagon,GLU)表达情况。结果 4组术后并发症发生率呈现随胃管插管时长而上升的趋势,Ⅳ组术后并发症发生率明显低于其他3组,差异有统计学意义(P<0.05);Ⅳ组胃肠功能最早恢复,其它3组胃肠功能恢复时长呈现随胃管插管时长而上升的趋势,表现为首次排气时间、首次排便时间、肠鸣音恢复时间Ⅳ组明显更低,差异有统计学意义(P<0.05);VIP、MTL、GLU的变化4组术前及术后1 d,差异无统计学意义,Ⅳ组术后3 d VIP值低于另外3组,上升趋势与拔管时间延长一致,差异均有统计学意义(P<0.05);MTL值术后3 d、7d递减趋势与拔管时间延长一致,Ⅳ组水平最高,差异均有统计学意义(P<0.05);术后3 d、7 d GLU上升趋势与拔管时间延长一致,Ⅳ组最低,差异均有统计学意义(P<0.05)。结论胃肠手术不采取常规留置胃管,术后并发症发生率更低、胃肠功能恢复更快,留置胃管时间越短患者康复越快,安全性越高。
引文
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[2]?zgü?H, Yilmazlar T,?mer Yerci, et al. Analysis of prognostic and immunohistochemical factors in gastrointestinal stromal tumors with malignant potential[J]. Journal of Gastrointestinal Surgery,2005,9(3):418-429.
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[4]卫生部.抗菌药物临床应用指导原则[J].柳州医学,2005,14(4):196-202.
[5] Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection:a randomised controlled trial[J]. Lancet, 2002,359(9320):1812-1818.
[6] Gerber A. An appraisal of paralytic ileus and the necessity for postoperative gastrointestinal Suction[J]. Surgery Gynecology&Obstetrics, 1963, 117(2):294.
[7]孙海波,李印,刘先本,等.食管癌微创手术后不放胃管不禁食的可行性研究[J].中华胃肠外科杂志,2014,17(9):898-901.
[8] Argov S, Goldstein I, Barzilai A. Is routine use of the nasogastric tube justified in upper abdominal surgery?[J]. American Journal of Surgery, 1980, 139(6):849-850.
[9]赵威.手术室护理干预对胃肠道手术患者切口愈合效果及并发症、护理满意度的影响[J].当代医学,2018,24(5):170-171.