经鼻型肠梗阻导管联合泛影葡胺治疗腹部术后粘连性小肠梗阻临床分析

发布时间：2018-02-09 17:26

本文关键词： 肠梗阻导管泛影葡胺粘连性小肠梗阻　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨经鼻型肠梗阻导管联合泛影葡胺对腹部术后粘连性小肠梗阻治疗效果。方法:统计回顾分析2013年9月到2016年9月大连医科大学附属第二医院收治的腹部术后粘连性小肠梗阻患者共206例,并分为5组。其中对照组A:给予传统的经鼻胃管减压治疗方案,对照组B:给予传统经鼻胃肠减压联合药物泛影葡胺注射液治疗方案,对照组C:仅单纯应用经鼻型肠梗阻导管治疗方案,对照组D:给予单纯口服泛影葡胺治疗方案,实验组E:应用经鼻型肠梗阻导管同时给予药物泛影葡胺注射液联合治疗方案。其中,应用药物泛影葡胺注射液治疗组患者,经口服或经鼻胃管或经鼻型肠梗阻导管注入60-100mL 76%的泛影葡胺注射液,注药后夹闭导管2小时,密切观察收治患者的临床症状及体征变化,并观测患者腹部立卧位以及腹部螺旋CT影像学变化,动态监测患者肠梗阻病情有无加重及缓解。比较5组患者的腹痛、腹胀等临床症状缓解时间、治疗后初次排便时间、患者住院天数及治疗有效率。结果:实验组及对照组放置肠梗阻导管及传统胃管治疗患者均按照要求导管放置成功,与对照组经传统鼻胃管、经传统鼻胃管联合药物泛影葡胺注射液、单纯应用药物泛影葡胺注射液以及单纯应用经鼻型肠梗阻导管治疗方案相比,经鼻型肠梗阻导管联合泛影葡胺注射液治疗组患者,其患者腹痛腹胀等临床症状缓解时间、治疗后初次排便时间、住院时间等情况均要明显优于对照组(p0.05),差异具备统计学意义(p0.05)。结论:1、经鼻型肠梗阻导管联合泛影葡胺注射液方案在腹部术后粘连性小肠梗阻的治疗中效果显著且安全性高,并能降低肠梗阻中转手术率,降低粘连性肠梗阻的复发概率。2、肠梗阻导管联合泛影葡胺注射液治疗粘连性肠梗阻方案可有效、快速判断肠梗阻部位及程度,快速的缓解患者临床症状,减轻患者痛苦,同时也为保守治疗无效的手术治疗患者提供了良好的手术时机及条件。
[Abstract]:Objective: to investigate the effect of transnasal intestinal obstruction catheter combined with meglumine diatrizoate in the treatment of adherent intestinal obstruction after abdominal operation. Methods: from September 2013 to September 2016, the abdominal cavity in the second affiliated Hospital of Dalian Medical University was analyzed retrospectively. There were 206 cases of adhesive small bowel obstruction after operation. Control group A: traditional nasogastric tube decompression regimen, control group B: traditional nasal gastrointestinal decompression combined with meglumine diatrizoate injection. Control group C was treated with transnasal intestinal obstruction catheter only, control group D was treated with oral meglumine diatrizoate alone, the control group was treated with meglumine diatrizoate alone. The experimental group E: the patients in the treatment group were treated with drug diatrizoate meglumine injection simultaneously with transnasal intestinal obstruction catheter, among which, the patients in the treatment group were treated with meglumine diatrizoate injection. 60-100 mL of meglumine diatrizoate injection was injected through oral or nasal stomach tube or nasal obstruction catheter. The catheter was clipped for 2 hours. The changes of clinical symptoms and signs of the patients were observed closely. The clinical symptoms of abdominal pain, abdominal distension and other clinical symptoms in five groups were compared, and the first defecation time after treatment was compared, and the imaging changes of abdominal position and spiral CT were observed, and the severity and remission of intestinal obstruction were dynamically monitored, and the clinical symptoms such as abdominal pain and abdominal distension were compared among the five groups. Results: the patients in the experimental group and the control group were successfully placed with intestinal obstruction catheter and traditional gastric tube according to the request, and the control group was treated with the traditional nasogastric tube. Compared with the traditional nasogastric tube combined with meglumine diatrizoate injection, meglumine diatrizoate injection alone and transnasal obstruction catheter alone, the patients in the treatment group were treated with transnasal obstruction catheter combined with meglumine diatrizoate injection. The time of relief of clinical symptoms such as abdominal pain and abdominal distension, the time of first defecation after treatment, The hospitalization time was significantly better than that in the control group (P 0.05), and the difference was statistically significant (P 0.05). Conclusion: the transnasal intestinal obstruction catheter combined with meglumine diatrizoate injection is effective and safe in the treatment of adhesive small intestinal obstruction after abdominal operation. It can reduce the conversion rate of intestinal obstruction and reduce the recurrence probability of adhesive intestinal obstruction. The combination of intestinal obstruction catheter and meglumine diatrizoate injection can be used to treat adhesive intestinal obstruction, and the location and degree of intestinal obstruction can be determined quickly. Rapid relief of clinical symptoms and pain, but also for the conservative treatment of ineffective surgery to provide a good opportunity and conditions.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.7

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