颈髓外伤伴截瘫患者围手术期的消化系统管理
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摘要
目的回顾性分析消化系统管理在颈椎外伤伴截瘫患者中的临床应用。方法分析2011-2013年上海长征医院脊柱外科84例采用消化系统管理模式处理颈椎外伤伴截瘫患者的临床资料,包括年龄、性别、致伤因素、颈椎受伤节段、手术情况、腹部管理方法及预后,统计经处理后腹部症状的缓解情况。对颈椎外伤伴截瘫患者的消化管理,我科采用的是营养支持、液体管理、物理刺激、有效通便等方法。结果通过围手术期有效的消化系统管理,67例患者(82%)的腹部症状不同程度的得到了缓解,无1例行结肠造瘘,提高了生存质量。结论及时、合理的消化系统管理模式可以有效降低颈椎外伤伴截瘫患者的腹部症状,提升患者围手术期生存质量。
Objective To analyzed the digestive system management clinical application in patients with cervical spine injury with paraplegia in perioperative period,retrospectively. Methods Analysis of Shanghai changzheng hospital spinal surgery in 2011-2013,84 patients with digestive system management mode of treatment of cervical vertebra trauma patients with paraplegia with clinical data,including age, gender,injury factors,cervical vertebra injured segments,operation situation,abdominal management methods and prognosis,statistical via abdomen symptom relief after processing.Digestive management of patients with paraplegia with cervical vertebra trauma,our methods are the nutrition support, fluid management,physical stimuli,effective purge and so on. Results Through perioperative effective digestive system managemen,67 patients' s abdominal symptoms eased in the varying degree, no one had colostomy. That method proved to improve the quality of life. Conclusion Reasonable and timely digestive system management can effectively reduce the cervical vertebra trauma patients with paraplegia with abdominal symptoms, improving quality of life of postoperative patients.
Objective To analyzed the digestive system management clinical application in patients with cervical spine injury with paraplegia in perioperative period,retrospectively. Methods Analysis of Shanghai changzheng hospital spinal surgery in 2011-2013,84 patients with digestive system management mode of treatment of cervical vertebra trauma patients with paraplegia with clinical data,including age, gender,injury factors,cervical vertebra injured segments,operation situation,abdominal management methods and prognosis,statistical via abdomen symptom relief after processing.Digestive management of patients with paraplegia with cervical vertebra trauma,our methods are the nutrition support, fluid management,physical stimuli,effective purge and so on. Results Through perioperative effective digestive system managemen,67 patients' s abdominal symptoms eased in the varying degree, no one had colostomy. That method proved to improve the quality of life. Conclusion Reasonable and timely digestive system management can effectively reduce the cervical vertebra trauma patients with paraplegia with abdominal symptoms, improving quality of life of postoperative patients.
引文
[1]Pacheco MS,Garstang SV.Gas tric dysmotility after abdominal surgery in persons with cervical spinal cord injury:a case series[J].J Spinal Cord Med,2007,30(4):378-384.
[2]王新伟,袁文,陈德玉,等.严重颈椎脱位手术治疗策略探讨[J].中华外科杂志,2007,45(6):379-382.
[3]Adriaansen JJ,van Asbeck FW,van Kuppevelt D,et al.Outcomes of neurogenic bowel management in individuals living with a spinal cord injury for at least ten years[J].Arch Phys Med Rehabil,2015(15):41-46.
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[7]白春宏,王莎莉,安洪,等.急性脊髓损伤后家兔肠道菌群移位和内毒血症的肠道病理生理机制[J].第三军医大学学报,2010,32(6):580-583.
[8]王新伟,顾韬,袁文,等.伴交感神经症状颈椎病的治疗及其机制[J].中华外科杂志,2008,46(18):1424-1427.
[9]Hu C,Ye M,Huang Q.Effects of manual therapy on bowel function of patients with spinal cord injury[J].J Phys Ther Sci,2013,25(6):687-688.
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[12]Matsumoto T,Tamaki T,Kawakami M,et al.Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury[J].Spine,2001,26(4):426-430.
[13]Engkasan JP,Sudin SS.Neurogenic bowel management after spinal cord injury:Malaysian ex perience[J].J Rehabil Med,2013,45(2):141-144.
[14]Altzstein RJ,Mustin E,Koch TR.Gut hormone release in patients after spinal cord injury[J].Am J Phys Med Rehabil,1995,74(5):339-44.
[15]Sun WM,Mac Donagh R,Forster D,et al.Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy[J].Gastroenterology,1995,108(4):990-998.
[16]Stone JM,Nino-Murcia M,Wolfe VA,et al.Chronic gastrointestinal problems in spinal cord injury patients:a prospective analysis[J].Am J Gastroenterol,1990,85(9):1114-1119.
[17]朱巍,阚利胜,孙延卿,等.呼吸道系统管理模式对降低颈脊髓完全损伤气管切开风险的意义[J].中华医学杂志,2014,94(13):999-1002.
[18]Fynne L,Worsфe J,Gregersen T,et al.Gastric and small intestinal dysfunction in spinal cord injury patients[J].Acta Neurol Scand,2012,125(2):123-128.
[19]Liu MY,Wang CW,Wu ZP,et al.Electroacupuncture for the prevention of postoperative gastrointestinal dysfunction in patients undergoing vascular surgery under general anesthesia:study protocol for a prospective practical randomized controlled trial[J].J Integr Med,2014,12(6):512-519.
[20]Kwok S,Harvey L,Glinsky J,et al.Does regular standing improve bowel function in people with spinal cord injury?A randomised crossover trial[J].Spinal Cord,2015,53(1):36-41.
[21]Janssen TW,Prakken ES,Hendriks JM,et al.Electromechanical abdominal massage and colonic function in individuals with a spinal cord injury and chronic bowel problems[J].Spinal Cord,2014,52(9):693-696.
[22]尹燕红,王华飞.中药外敷神阙穴治疗胸腰椎骨折腹胀便秘56例[J].中国中医药现代远程教育,2013,21:44-44.
[2]王新伟,袁文,陈德玉,等.严重颈椎脱位手术治疗策略探讨[J].中华外科杂志,2007,45(6):379-382.
[3]Adriaansen JJ,van Asbeck FW,van Kuppevelt D,et al.Outcomes of neurogenic bowel management in individuals living with a spinal cord injury for at least ten years[J].Arch Phys Med Rehabil,2015(15):41-46.
[4]Faaborg PM,Christensen P,Krassioukov A,et al.Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury[J].Spinal Cord,2014,52(6):494-498.
[5]Janssen TW,Prakken ES,Hendriks JM,et al.Electromechanical abdominal massage and colonic function in individuals with a spinal cord injury and chronic bowel problems[J].Spinal Cord,2014,52(9):693-696.
[6]Ebert E.Gastrointestinal involvement in spinal cord injury:a clinical perspective[J].J Gastrointestin Liver Dis,2012,21(1):75-82.
[7]白春宏,王莎莉,安洪,等.急性脊髓损伤后家兔肠道菌群移位和内毒血症的肠道病理生理机制[J].第三军医大学学报,2010,32(6):580-583.
[8]王新伟,顾韬,袁文,等.伴交感神经症状颈椎病的治疗及其机制[J].中华外科杂志,2008,46(18):1424-1427.
[9]Hu C,Ye M,Huang Q.Effects of manual therapy on bowel function of patients with spinal cord injury[J].J Phys Ther Sci,2013,25(6):687-688.
[10]Park HK,Song DH,Kim YM,et al.Intractable abdominal pain in a patient with spinal cord injury:a case report[J].Ann Rehabil Med,2013,37(5):721-724.
[11]Kwok S,Harvey L,Glinsky J,et al.Does regular standing improve bowel function in people with spinal cord injury A randomised crossover trial[J].Spinal Cord,2015,53(1):36-41.
[12]Matsumoto T,Tamaki T,Kawakami M,et al.Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury[J].Spine,2001,26(4):426-430.
[13]Engkasan JP,Sudin SS.Neurogenic bowel management after spinal cord injury:Malaysian ex perience[J].J Rehabil Med,2013,45(2):141-144.
[14]Altzstein RJ,Mustin E,Koch TR.Gut hormone release in patients after spinal cord injury[J].Am J Phys Med Rehabil,1995,74(5):339-44.
[15]Sun WM,Mac Donagh R,Forster D,et al.Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy[J].Gastroenterology,1995,108(4):990-998.
[16]Stone JM,Nino-Murcia M,Wolfe VA,et al.Chronic gastrointestinal problems in spinal cord injury patients:a prospective analysis[J].Am J Gastroenterol,1990,85(9):1114-1119.
[17]朱巍,阚利胜,孙延卿,等.呼吸道系统管理模式对降低颈脊髓完全损伤气管切开风险的意义[J].中华医学杂志,2014,94(13):999-1002.
[18]Fynne L,Worsфe J,Gregersen T,et al.Gastric and small intestinal dysfunction in spinal cord injury patients[J].Acta Neurol Scand,2012,125(2):123-128.
[19]Liu MY,Wang CW,Wu ZP,et al.Electroacupuncture for the prevention of postoperative gastrointestinal dysfunction in patients undergoing vascular surgery under general anesthesia:study protocol for a prospective practical randomized controlled trial[J].J Integr Med,2014,12(6):512-519.
[20]Kwok S,Harvey L,Glinsky J,et al.Does regular standing improve bowel function in people with spinal cord injury?A randomised crossover trial[J].Spinal Cord,2015,53(1):36-41.
[21]Janssen TW,Prakken ES,Hendriks JM,et al.Electromechanical abdominal massage and colonic function in individuals with a spinal cord injury and chronic bowel problems[J].Spinal Cord,2014,52(9):693-696.
[22]尹燕红,王华飞.中药外敷神阙穴治疗胸腰椎骨折腹胀便秘56例[J].中国中医药现代远程教育,2013,21:44-44.