直肠癌术后咀嚼口香糖促进胃肠康复的随机对照研究(1)

http://www.100md.com 2011年5月1日 《中国保健营养·临床医学学刊》 2011年第9期

     摘要：目的 探讨直肠癌术后咀嚼口香糖促进胃肠功能恢复的有效性。方法 前瞻性纳入2010年1月至2010年7月行择期直肠癌手术的患者160例，并随机分为实验组(n=80)和对照组(n=80)。实验组术后咀嚼口香糖，对照组术后不咀嚼口香糖。盲法采集术后胃肠功能恢复情况和胃肠道并发症指标，并比较两组间的差异。结果 本研究实际纳入病例155例，实验组78例，对照组77例，两组患者基本情况一致。所有纳入患者均能良好耐受术后咀嚼口香糖。实验组术后首次闻及肠鸣音时间(P＝0.036)，首次排气时间、首次排便时间和术后住院时间明显短于对照组(P<0.001)。实验组术后腹胀和术后肠梗阻的发生率明显低于对照组(P<0.01)，但是术后恶心、术后呕吐的发生率两组间无统计学差异(P>0.05)。结论 直肠癌术后咀嚼口香糖能够促进患者术后胃肠功能的恢复，减轻术后胃肠道不适，缩短住院日，提高生活质量。

    关键词：直肠癌 咀嚼口香糖 胃肠康复 随机对照试验

    A Randomized Controlled Trial of Chewing Gum to Promote Postoperative Bowel Recovery for Patients with Rectal Cancer

    Wang Shao-Yuan Hou Ying-kui Dong Shi-ping liu bie-yin zhang kai

    Department of General Surgery, First People’s Hospital of Guangyuan (Guangyuan 628017)

    Corresponding author: Hou Ying-kui, Email: Email: 1226413620@qq.com [Abstract]Objective: To determine the effectiveness of chewing gum in promoting postoperative bowel recovery for patients with rectal cancer. Methods: Prospectively enrolled 160 patients underwent elective rectal cancer from January 2010 to July 2010, were randomly assigned into two groups. The patients in experimental group (n=80) were given gum for chewing postoperatively, while nothing was offered to control group (n=80). The outcomes were blindly assessed and compared between two groups, including postoperative bowel function recovery situation and complications. Results: 155 patients underwent rectal cancer were enrolled in experimental group (n=78) and control group (n=77). The baselines characteristics of two groups were statistically similar. All the patients tolerated chewing gum well. The postoperative intestinal sounds first heard was significantly shorter in experimental group as compared to control group (P=0.036), as well as passage of first flatus, first bowel movement and length of postoperative hospital stay(p<0.001). Moreover, the incidence of abdominal distension and ileus was significantly lower in experimental group as compared to control group (P<0.01). However, no statistical difference was found in occurrence of postoperative nausea, vomiting (P>0.05). Conclusion: Chewing gum for patients with rectal cancer could enhance the postoperative bowel function recovery, relieve gastrointestinal discomfort, shorten the hospital stay, and finally improve the postoperative quality of life.

    Key words：Rectal Cancer; Chewing Gum; Bowel Recovery; Randomized Controlled Trial

    中图分类号：R73文献标识码：B文章编号：1004-7484(2011)18-0057-04

    术后肠梗阻是直肠癌术后的常见并发症之一，研究显示其发生率为26%～31%[1]。术后胃肠功能的延迟恢复会导致腹胀、恶心、呕吐等不适，降低患者的术后生活质量，延长术后住院日。而且由于直肠癌手术的特殊性，医生从安全的角度考虑倾向于延长患者术后的禁食时间，减少吻合口瘘发生的风险，阻碍了患者的术后胃肠功能康复。本研究利用“假饲”原理，采用随机对照试验探讨直肠癌术后咀嚼口香糖促进胃肠功能恢复的有效性。

    1 资料与方法

    1.1 临床资料

    本研究拟前瞻性纳入2010年1月～2010年7月期间于我院住院行择期直肠癌手术患者160例。排除标准：①急诊入院行剖腹探查者；②合并严重内科疾病，术后需进入重症监护室者；③既往有明确消化道疾病者，包括胃肠溃疡、肠易激综合征、慢性胃肠炎、肠疝等。剔除标准：①术后不能耐受咀嚼口香糖者；②未达出院标准要求自动出院者。根据电脑生成的随机数字表将纳入患者分为2组，实验组(n=80)术前咀嚼口香糖，对照组(n=80)术后不咀嚼口香糖。本研究通过医院伦理委员会审核，所有患者纳入前均签署知情同意书。

    1.2 方法

    所有患者都由同一医疗组实施直肠癌根治手术或姑息手术。所有患者均采用全身麻醉，术后均予以镇痛泵止痛。术后由专职研究员负责对纳入患者进行随机分组，采用密闭不透光的信封保存随机分组序列，严格实施分配隐藏。由专职研究员给实验组患者发口香糖，并督促患者按时咀嚼。实验组在术后6小时开始咀嚼口香糖，白天每4小时1次，每次咀嚼15分钟，直到首次排气时为止，夜间不咀嚼口香糖。对照组不咀嚼口香糖。两组患者术后首次闻及肠鸣音后开始饮水，排气后进食流质。由一专职住院医师负责结局测量，询问患者是否排气以及恶心、呕吐、腹胀等不适，记录患者是否能耐受术后咀嚼口香糖，以及排气和排便时间。对专职测量结局的住院医师实施盲法。为观察直肠癌术后患者胃肠功能恢复的完整过程，本研究设定出院标准为能够耐受固体食物、生活能够自理，肛门已排便，病人同意出院，体温正常。(王少渊 侯英奎 董世平 刘别影 张凯)

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