In order to observe electrolyte changes before and after scheduled abdominal surgery and effect of prompt potassium supplement on the recovery of gastrointestinal function, electrolytes in 69 patients were tested before and after surgery, and the recovery of the gastrointestinal function was observed.The results showed that after surgery the levels of K＋, Na＋ and Cl＋ were decreased dramatically (Ｐ＜0.05) but still within the normal range, with no distinctive change in Ca２＋ and Mg２＋. No correlation between the amount of blood transfusion and potassium was detected. Prompt potassium supplement contributed to the quick recovery of gastrointestinal function.This suggests that with normal renal function, blood transfusion during the operation will not cause hyperkalemia, potassium supplement might begin on the first day when the patient begins to urinale.
【摘要】 目的 比较术后芬太尼皮下镇痛（PCSA）与硬膜外镇痛（PCEA）的临床效果，以及对胃肠功能的影响。 方法 2009年1-6月间观察择期硬膜外麻醉下经腹子宫切除术患者120例，术后分别实施PCSA与PCEA，观察术后第4、8、12、24、48 h的镇痛、镇静情况，呼吸循环、恶心呕吐及其他不良事件，记录术后首次肛门排气时间，测评术后镇痛满意度。 结果 术后两组患者镇痛优良率均在90%以上，各时点镇痛评分、镇静评分、恶心呕吐发生率、首次肛门排气时间以及患者镇痛优良率差异均无统计学意义（Pgt;0.05）。 结论 术后芬太尼PCSA与PCEA一样，效果确切，对术后胃肠功能无明显影响，患者满意，是一种安全、有效的镇痛方法。【Abstract】 Objective To compare clinical efficiency and gastrointestinal reaction of subcutaneous patient-controlled analgesia (PCSA) and epidural patient-controlled analgesia (PCEA) with fentanyl analgesic for patients after operation. Methods A total of 120 patients having undergone transabdominal hysterectomy under epidural anesthesia between January and June 2009 accepted PCSA or PCEA after operation. We evaluated the state of analgesia and sedation at the 4th, 8th, 12th, 24th and 48th hour after operation. We also looked into the respiration, blood circulation, nausea, vomiting and other abnormal events of the patients during the first 48 hours after operation. At the same time, we recorded the first time of anal exsufflation after operation and the degree of patients’ satisfaction. Results The analgesic effective rate was higher than 90% in both groups. There were no significant differences in analgesia and sedation scores at above-mentioned points after operation, incidence of nausea and vomiting, first time of anal exsufflation or analgesic effective rate between the two groups. Conclusion PCSA with fentanyl can be as effective in relieving postoperative pain as PCEA with fentanyl without obvious adverse effect in the gastrointestinal function. Therefore, PCSA is a safe and effective method to alleviate postoperative pain.
【摘要】 目的 探讨远端胃癌根治术后早期经口进食的可行性、安全性及术后早期康复情况。 方法 将2009年5月-2011年1月收治的62例远端胃癌根治术患者随机分为早期经口进食（early oral feeding，EOF，30例）组及传统进食（traditional feeding，TF，32例）组。比较两种营养支持方法对患者术后并发症、胃肠功能恢复及血清蛋白的影响。 结果 EOF组术后早期经口进食耐受率达90%（27/30），两组术后并发症发生率相比差异无统计学意义（χ2=0.046，P=0.830）。EOF组术后首次肛门排气及排便时间均早于TF组（P=0.000）。术后8 d时EOF组血清前清蛋白和转铁蛋白明显高于TF组（P=0.028，0.013）。 结论 远端胃癌根治术后早期经口进食是安全、可行的，能促进患者的早期恢复。【Abstract】 Objective To discuss the feasibility and safety of early oral feeding after curative surgery for distant gastric cancer, and investigate whether it has an effect on early recovery of the disease. Methods From May 2009 to January 2011, 62 distal gastric cancer patients with open radical resection were divided into the early oral feeding group (EOF group, n=30) and traditional feeding group (TF group, n=32) randomly. We compared the complication rate, gastrointestinal function recovery, serum protein change before and after operation between the two groups. Results Early oral feeding can be tolerated by as much as 90% (27/30) of the patients in EOF group. There was no significant difference in the postoperative complication rate between the two groups (χ2=0.046, P=0.830). The EOF group had a faster onset of flatus and defecation than the TF group (P=0.000). The serum pre-albumin and transferrin were significantly higher in the EOF group than those in the TF group 8 days after operation (P=0.028,0.013). Conclusion Early oral feeding after curative surgery for distal gastric cancer is safe and feasible, and can promote early rehabilitation of the patients.
Objective To investigate the relationship between the gastrointestinal function and ventilator-associated pneumonia (VAP) in critically ill patients who underwent invasive mechanical ventilation. Methods One-hundred and fifty-three cases of critically ill patients receiving mechanically ventilation were recruited in the study. After 5 days of ventilation, the gastrointestinal function score and the C-reactive protein (CRP) of each patient were recorded. The incidence of VAP was recorded during hospitalization. According to the incidence of VAP, all patients were divided intoaVAP group and a non-VAP group. The relationship between gastrointestinal function score and the incidence of VAP was analyzed. The relationship between CRP level and severity degree of VAP was also analyzed. Results VAP occurred in 42 cases with the incidence of 27.45%. The gastrointestinal function score (1.9±1.0 vs. 0.8±1.0, P < 0.05) and CRP level [(52.38±12.06) mg/L vs. (36.69±11.08)mg/L, P < 0.05] were both higher in the VAP group than those in the non-VAP group. At gastrointestinal function score of 0 - 3, the CRP levels were all higher in the VAP group than those in the non-VAP group (P < 0.05). The incidence of VAP was 8.33%, 23.68%, 45.45%, and 59.09% at gastrointestinal function score of 0, 1, 2 and 3, respectively, with significant differences between each other(P < 0.05). Conclusion For critically ill patients receiving invasive mechanical ventilation, the more severe the damage of gastrointestinal function is, the higher the incidence of VAP is, and the more serious the disease is.
ObjectiveTo investigate the role of somatostatin in gastrointestinal function after operation for treatment of abdominal injury patients. MethodsSixty patients with abdominal trauma were divided into somatostatin in treatment group (n=30) and the conventional treatment control group (n=30). The amount of gastrointestinal decompression drainage, bowel sounds recovery time, exhaust time, defecation time, and the levels of serum C reactive protein, TNF-α, IL-6, and IL-8 after operation in two groups were observed. ResultsSomatostatin treatment group recovery time of bowel sounds, exhaust time, and defecation time were earlier than the control group, hospitalization time shortened, and the amount of gastrointestinal decompression drainage reduced (P < 0.05), The levels of serum C reactive protein, TNF-α, IL-6 and IL-8 of somatostatin treatment group were lower than those in control group (P < 0.05), and the magnitude of decline above index in the somatostatin treatment group were greater than that in the control group (P < 0.05). ConclusionSomatostatin can promote the recovery of gastrointestinal function in patients after operation in abdominal injury.
ObjectiveTo investigate the influence of enteral nutrition (EN) and total parenteral nutrition (TPN) on liver, kidney and gastrointestinal function in patients after esophagectomy. MethodsA total of 124 patients with esophageal cancer who underwent esophagectomy in the Affiliated Hospital of Guangdong Medical College from January 2012 to August 2013 were enrolled in this study. There were 71 male and 53 female patients with their average age of 59.7 years (range 31 to 85 years). All the patients were randomly divided into an experimental group and a control group. Postoperatively, patients in the experimental group received EN via nasogastric/nasointestinal tube, and patients in the control group received TPN. Preoperatively, 1, 3 and 7 days postoperatively, plasma alanine transaminase (ALT), aspartate transaminase (AST), indirect bilirubin (I_BIL), direct bilirubin (DB), total bilirubin (TB), total protein (TP) and albumin (ALB) were examined to evaluate liver function, blood urea nitrogen (BUN) and serum creatinine (Scr) were examined to evaluate renal function. Postoperative time to first audible bowel sounds, time to first flatus, and time to first stool were examined to evaluate gastrointestinal function. ResultsThere was no statistical difference in ALT, AST, I_BIL, DB or TB preoperatively and on the 1st postoperative day between the 2 groups (P > 0.05), but these parameters of the experimental group were significantly lower than those of the control group on the 3rd and 7th postoperative day (P < 0.05). There was no statistical difference in TP or ALB between the 2 groups (P > 0.05). There was no statistical difference in BUN or Scr preoperatively, on the 1st or 3rd postoperative day between the 2 groups (P > 0.05). BUN (4.94±1.07 mmol/L vs. 6.67± 2.88 mmol/L, P < 0.05) and Scr (52.50±12.46 μmol/L vs. 68.23±7.61 μmol/L, P < 0.05) of the experimental group were significantly lower than those of the control group on the 7th postoperative day. Postoperative time to first audible bowel sounds (42.00±1.68 hours vs. 50.00±1.54 hours), time to first flatus (64.15±10.35 hours vs. 70.64±14.73 hours) and time to first stool (4.20±1.50 days vs. 5.20 ±1.40 days) of the experimental group were significantly shorter than those of the control group (P < 0.05). ConclusionPostoperative EN can promote the recovery of gastrointestinal function, and has less influence on liver and kidney function, which is beneficial to postoperative recovery and morbidity reduction after esophagectomy.
Objective To analyze clinical value of early enteral nutrition following radical resection of gastric cancer. Methods Seventy-six patients with gastric cancer underwent radical resection from May 1, 2016 to July 1, 2016 in the West China Hospital of Sichuan University were included according to the inclusion criteria and exclusion criteria, then were randomly divided into observation group (36 cases) and control group (40 cases). The patients in the observation group received the enteral nutrition on day 2 following the surgery, in the control group received the conventional management. The gastrointestinal recovery and the adverse reaction were compared in these two groups. The preoperative and postoperative laboratory indicators and the body weight of the patients in both groups were analyzed. Results ① The general data such as age, gender, and body weight had no significant differences in these two groups (P>0.05). ② The first anus exhaust time and the first defecation time of the observation group were significantly shorter than those of the control group (P<0.05). ③ The adverse reaction rate of the observation group was significantly lower than that of the control group (P<0.05). ④ On admission, the serum albumin, urea nitrogen, creatinine, and lymphocyte count had no significant differences in these two groups (P>0.05). On day 5 after the operation, the serum albumin of the observation group was significantly higher than that of the control group (P<0.05). ⑤ The body weight had no significant difference in these two groups before the operation (P>0.05), which in the observation group was significantly heavier than that of the control group on day 30 after the operation (P<0.05). Conclusion Preliminary results of limited cases in this study show that early enteral nutrition following radical resection of gastric cancer is safe and effective, it could promote gastrointestinal function resumption and effectively improve nutritional status.
ObjectiveTo systematically review the effect and influence of gum chewing on the recovery of gastrointestinal function in gynecological patients after operation. MethodsEBSCO, MEDLINE, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials of gum chewing on gastrointestinal function recovery in patients after gynecological surgery from inception to September 30th, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. RevMan 5.3 software was then used to perform the meta-analysis. ResultsA total of 9 studies were included, involving 962 patients. Meta-analysis results showed that the time of first flatus (MD=–8.34, 95%CI –10.72 to –5.95, P<0.000 01), the time of first defecation (MD=–14.97, 95%CI –29.28 to –0.66, P<0.04), and the recovery time of bowel sounds (MD=–5.83, 95%CI –10.15 to –1.51, P=0.008) of gum chewing group was significantly shorter than that of the control group, and the incidence of abdominal distension was decreased after gynecological surgery (RR=0.24, 95%CI 0.08 to 0.74, P=0.01). According to the results of subgroup analysis, the time of first flatus of the gum chewing group was significantly shorter than that of the control group in laparoscopy (MD=–5.43, 95%CI –7.12 to –3.73, P<0.000 01), laparotomy (MD=–10.46, 95%CI –13.56 to –7.97, P<0.000 01) and abdominal surgery (MD=–10.64, 95%CI –13.01 to –8.26, P<0.000 01); the first defecation time after laparotomy (MD=–29.18, 95%CI –46.03 to –12.33, P=0.000 7), and abdominal surgery (MD=–14.24, 95%CI –24.27 to –4.21, P=0.005) in chewing gum group was significantly shorter than that in the control group; however, there was no significant difference in the laparoscopy group (MD=–2.97, 95%CI –12.94 to 7.00, P=0.56). ConclusionsThe systematic review and meta-analysis shows that gum chewing after gynecological surgery can shorten the time of first flatus, first defecation, and first bowel movement, and reduce the incidence of abdominal distension. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo review the association of gut microbiota and postoperative gastrointestinal dysfunction (GID) in patients after abdominal surgery and to provide a new idea for the pathogenesis, prevention, and treatment of postoperative GID in patients after abdominal surgery.MethodThe related and latest literatures were reviewed by searching the literatures on “intestinal flora” “gut microbiota” “intestinal microbial population” “brain-gut axis” “gastrointestinal function” “gastric paralysis” “intestinal paralysis” and “ileus” from January 1, 2000 to April 2, 2021 in Chinese and English databases.ResultsGut microbiota diversity was closely related to postoperative GID symptoms in patients after abdominal surgery. Gut microbiota regulated gastrointestinal motility and mucosal barrier function by metabolizing food to produce metabolites such as 5-hydroxytryptamine, melatonin, short-chain fatty acid, succinic acid, lactic acid, and so on.ConclusionsThe imbalance of gut microbiota is closely related to postoperative GID in patients after abdominal surgery. However, the relevant bacterial metabolites that have been found are limited at present, and the relevant mechanism needs to be further investigated.