Cali R L, Meade P G, Swanson M S, Freeman C
Department of Surgery, Pitt County Memorial Hospital, East Carolina University School of Medicine, Greenville, North Carolina, USA.
Dis Colon Rectum. 2000 Feb;43(2):163-8. doi: 10.1007/BF02236975.
Return of bowel function remains the rate-limiting factor in shortening postoperative hospitalization of patients with colectomies. Narcotics are most commonly used in the management of postoperative pain, even though they are known to affect gut motility. Narcotic use has been felt to be proportional to the length of the abdominal incision. The aim of this study was to determine whether return of bowel function after colectomy is directly related to narcotic use and to evaluate the effect of incision length on postoperative ileus.
A prospective evaluation of 40 patients who underwent uncomplicated, predominantly left colon and rectal resections was performed. Morphine administered by patient controlled analgesia was the sole postoperative analgesic. The amount of morphine used before the first audible bowel sounds, first passage of flatus and bowel movement, and incision length were recorded. Spearman correlation coefficients were calculated between all variables.
The strongest correlation was between time to return of bowel sounds and amount of morphine administered (r = 0.74; P = 0.001). There were also significant correlations between morphine use and time to report of first flatus (r = 0.47; P = 0.003) and time to bowel movement (r = 0.48; P = 0.002). There was no relationship between incision length and morphine use or incision length and return of bowel function in the total group.
Return of bowel sounds, reflecting small-intestine motility after colectomy, correlated strongly with the amount of morphine used. Similarly, total morphine use adversely affects colonic motility. Because no relationship with incision length was found, efforts to optimize the care of patients with colectomies should be directed less toward minimizing abdominal incisions and more toward diminishing use of postoperative narcotics.
肠功能恢复仍然是缩短结肠切除术后患者住院时间的限速因素。尽管已知麻醉药会影响肠道蠕动，但在术后疼痛管理中最常使用麻醉药。人们认为麻醉药的使用与腹部切口长度成正比。本研究的目的是确定结肠切除术后肠功能恢复是否与麻醉药使用直接相关，并评估切口长度对术后肠梗阻的影响。
对40例行单纯性、主要为左半结肠和直肠切除术的患者进行前瞻性评估。患者自控镇痛给予的吗啡是唯一的术后镇痛药。记录首次听到肠鸣音、首次排气和排便前使用的吗啡量以及切口长度。计算所有变量之间的Spearman相关系数。
肠鸣音恢复时间与给予的吗啡量之间的相关性最强（r = 0.74；P = 0.001）。吗啡使用量与首次排气报告时间（r = 0.47；P = 0.003）和排便时间（r = 0.48；P = 0.002）之间也存在显著相关性。在整个研究组中，切口长度与吗啡使用量或切口长度与肠功能恢复之间没有关系。
反映结肠切除术后小肠蠕动的肠鸣音恢复与使用的吗啡量密切相关。同样，吗啡的总使用量对结肠蠕动有不利影响。由于未发现与切口长度有关，优化结肠切除术后患者护理的努力应更少地指向尽量减小腹部切口，而更多地指向减少术后麻醉药的使用。
