急腹症Ⅲ号鼻饲、灌肠治疗危重症患者胃肠功能障碍的临床疗效观察

来源:用户上传      作者:叶远玲　胡芳玉　张绍杰

　　[摘要] 目的 观察急腹症Ⅲ号鼻饲、灌肠治疗危重症患者胃肠功能障碍的临床疗效。 方法 选取2015年7月～2017年2月我院急诊科EICU收治的APACHEⅡ评分≥20分，年龄≥18岁的危重症患者86例为研究对象，随机分为治疗组及对照组，每组43例;两组均予相同基础治疗，治疗组患者在此基础上予以急腹症Ⅲ号鼻饲、灌肠治疗。记录治疗前、治疗1周后APACHEⅡ、MODS评分、胃肠功能评分、腹内压。 结果 治疗1周后，治疗组APACHEⅡ评分、MODS评分、胃肠功能评分、腹内压与治疗前比较，差异有统计学意义（P<0.05），且治疗组APACHEⅡ、MODS评分、胃肠功能评分及腹内压均优于对照组，差异有统计学意义（P<0.05）。治疗后，治疗组的肠蠕动、肛门排气与排便时间均低于对照组，差异有统计学意义（P<0.05）;治疗组的ACS与MODS并发症发生率均低于对照组，差异有统计学意义（P<0.05）。 结论 急腹症Ⅲ号鼻饲联合灌肠治疗可改善腹内压、胃肠功能評分、危重症评分，对危重患者胃肠功能障碍具有防治作用。
　　[关键词] 急腹症Ⅲ号;危重症患者;胃肠功能障碍;鼻饲;灌肠
　　[中图分类号] R269          [文献标识码] B          [文章编号] 1673-9701（2019）28-0076-04
　　[Abstract] Objective To observe the preventive and therapeutic effects of acute abdomen Ⅲ enema on gastrointestinal dysfunction in critically ill patients. Methods A tolal of 86 critically ill patients aged 18 years or older with APACHEⅡscore of ≥20 points who were admitted to EICU of the emergency department of our hospital from July 2015 to February 2017 were selected as subjects of study， and they were randomly divided into treatment group and control group， with 43 cases in each group. Both groups were given the same basic treatment. On the basis of this， patients in the treatment group were given acute abdomen Ⅲ nasal feeding and enema for treatment. APACHEⅡ， MODS score， gastrointestinal function score， and intra-abdominal pressure were recorded before treatment and one week after treatment. Results After one week treatment， the score of APACHE Ⅱ， MODS， the score of gastrointestinal function and intra-abdominal pressure in the treatment group， compared with those before treatment， and there were statistically significant differences （P<0.05）. And the APACHEⅡ， MODS score， gastrointestinal function score， and intra-abdominal pressure in the treatment group were better than those in the control group， and there were statistically significant differences （P<0.05）. After treatment， the time of intestinal peristalsis， anal exhaust and defecation in the treatment group were lower than those in the control group， and the difference was statistically significant （P<0.05）. The incidence of complications of ACS and MODS in treatment group was lower than that in control group， and the difference was statistically significant （P<0.05）. Conclusion Acute abdomen Ⅲ nasal feeding combined with enema can improve intra-abdominal pressure， gastrointestinal function score and critical illness score， and has a preventive and therapeutic effect on gastrointestinal dysfunction in critically ill patients.
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