CAJ | 학술논문

目的：探讨小肠双造口和肠液回输在重度腹腔感染患者中的临床应用。方法将2005年2月至2014年11月间淮安市第二人民医院收治的10例高位小肠穿孔致重度腹腔感染的患者纳入研究。所选病例均为急诊手术,行小肠部分切除加小肠远近端肠管双造口术。术后待肠道功能基本恢复、腹腔感染得到基本控制后,经鼻胃管实施肠内营养,将近端造口引出的肠液回输入远端肠襻。分别测定肠液回输前后机体对营养物质糖、脂肪及氮的平均吸收系数,并检测血清蛋白水平。结果肠液回输后,患者对糖、脂肪及氮的平均吸收系数均显著增加[糖：(90.9±7.8)%比(82.7±15.2)%, P<0.05﹔脂肪：(87.6±6.4)%比(59.1±10.8)%, P<0.01﹔氮：(82.4±9.8)%比(67.2±15.4)%, P<0.01]﹔血清中纤维连接蛋白[(285.6±3.6) mg/L比(157.0±22.6) mg/L,P<0.01]、转铁蛋白[(4.86±0.21) g/L比(3.60±0.25) g/L,P<0.05]和前白蛋白[(291.3±112.5) mg/L比(199.1±53.3) mg/L,P<0.05]水平亦高于肠液回输前。结论小肠双造口和肠液回输能明显改善重度腹腔感染患者对三大营养物质的吸收,从而避免了短肠综合征的发生。
목적：탐토소장쌍조구화장액회수재중도복강감염환자중적림상응용。방법장2005년2월지2014년11월간회안시제이인민의원수치적10례고위소장천공치중도복강감염적환자납입연구。소선병례균위급진수술,행소장부분절제가소장원근단장관쌍조구술。술후대장도공능기본회복、복강감염득도기본공제후,경비위관실시장내영양,장근단조구인출적장액회수입원단장반。분별측정장액회수전후궤체대영양물질당、지방급담적평균흡수계수,병검측혈청단백수평。결과장액회수후,환자대당、지방급담적평균흡수계수균현저증가[당：(90.9±7.8)%비(82.7±15.2)%, P<0.05﹔지방：(87.6±6.4)%비(59.1±10.8)%, P<0.01﹔담：(82.4±9.8)%비(67.2±15.4)%, P<0.01]﹔혈청중섬유련접단백[(285.6±3.6) mg/L비(157.0±22.6) mg/L,P<0.01]、전철단백[(4.86±0.21) g/L비(3.60±0.25) g/L,P<0.05]화전백단백[(291.3±112.5) mg/L비(199.1±53.3) mg/L,P<0.05]수평역고우장액회수전。결론소장쌍조구화장액회수능명현개선중도복강감염환자대삼대영양물질적흡수,종이피면료단장종합정적발생。
Objective To evaluate the application of small intestine double stoma and succus entericus reinfusion in the patients with severe intra-abdominal infection. Methods Ten patients with high intestinal perforation from February 2005 to November 2014 were enrolled in the study. All the cases received emergency operation. Small bowel with intestinal perforation was resected, and double stoma was applied in the proximal and distal small intestine. When abdominal infection under control, total enteral nutrition was successfully administered from nasogastric tube. The succus entericus from the proximal intestine was collected and transfused back to the distal intestine. Stool was collected and fecal nitrogen, fat and carbohydrate contents were determined. Related serum protein levels were measured. Results As compared to pre-reinfusion, the absorption rate of carbohydrate [(90.9±7.8)% vs. (82.7± 15.2)%], fat [(87.6±6.4)% vs. (59.1±10.8)%], and nitrogen [(82.4±9.8)% vs. (67.2±15.4)%] increased after succus entericus reinfusion (P<0.05). The serum protein levels increased significantly as well[fibronectin:(285.6±3.6) vs. (157.0±22.6) mg/L, P<0.01﹔transferrin:(4.86±0.21) vs. (3.60± 0.25) g/L,P<0.05﹔pre-albumin:(291.3±112.5) vs. (199.1±53.3) mg/L, P<0.05]. Conclusion Small intestine double stoma and succus entericus reinfusion are effective in improving the absorption of carbohydrate, fat and nitrogen in the patients with severe intra-abdominal infection.