传统的保存和鼻肠管放置在粘合性小肠阻塞中的效果的比较:一个匹配的病例控制研究
Hui Wang1, Jun-Rong Zhang1, Peng-Sheng Tu1
1Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Asian journal of surgery
|March 9, 2024
概括
鼻肠道管 (NIT) 和传统的保守 (TC) 治疗粘性小肠阻塞 (ASBO) 有特定的指示. 最佳的ASBO管理包括根据患者的生物标志物和反应量身定制治疗,在严重病例中保留手术.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 紧急医疗 紧急医疗
背景情况:
- 粘性小肠阻塞 (ASBO) 在紧急医疗中提出了重大挑战.
- 鼻肠道管 (NIT) 的放置提供了 in situ 减压,增加了其临床用途,而不是传统的保守 (TC) 管理.
- 在ASBO中,NIT与TC的最佳指示仍在争论中.
研究的目的:
- 在ASBO中划出NIT和TC治疗的特定指示.
- 根据治疗结果,提出ASBO的最佳管理策略.
- 为了确定ASBO治疗期间不良事件的危险因素.
主要方法:
- 倾向性得分匹配被用来创建NIT和TC治疗的可比组.
- 分析了128对患者,比较严重的不良事件,临床参数和放射性特征.
- 在治疗的两个阶段分析了副作用的独立风险因素.
主要成果:
- 正常的红细胞 (RBC) 水平和平衡的离子水平在第一阶段对TC治疗的成功产生了积极的影响.
- 在正常红血细胞或降低白血细胞水平的患者中,TC治疗的成功率为79.5%.
- 在可逆电解质失衡或中性粒细胞与淋巴细胞比率 (NLR) <4.3.3的患者中,NIT治疗的成功率为68.1%.
结论:
- 建议在ASBO患者中进行TC治疗,他们的红血细胞和水平在治疗前正常.
- 对于TC和NIT组,炎症生物标志物升高或不可逆转的电解质干扰表明人们更喜欢手术干预.
- 生物标志物和电解质平衡的动态监测对于指导ASBO治疗决策至关重要.
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