腹主动脉瘤修复手术后患者的远端小肠蠕动与脂质吸收

Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery.

作者信息

Fraser Robert J, Ritz Marc, Di Matteo Addolorata C, Vozzo Rosalie, Kwiatek Monika, Foreman Robert, Stanley Brendan, Walsh Jack, Burnett Jim, Jury Paul, Dent John

机构信息

Investigation and Procedures Unit, Repatriation General Hospital, Daw Park, Adelaide 5041, South Australia.

出版信息

World J Gastroenterol. 2006 Jan 28;12(4):582-7. doi: 10.3748/wjg.v12.i4.582.

DOI:10.3748/wjg.v12.i4.582

PMID:16489672

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4066091/

Abstract

AIM

To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.

METHODS

Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m(2)) post-surgery for AAA repair, and seven healthy control subjects (20-50 years; BMI range: 21-29 kg/m(2)) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison). Recordings were analyzed for the frequency, origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the (13)C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 microL (13)C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for (13)CO(2) concentration.

RESULTS

The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P<0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery. Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients, absorption on d 1 post-surgery was half that of healthy control subjects (AUC (13)CO(2) 1323+/-244 vs 2646+/-365; P<0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC (13)CO(2) 470+/-832 vs 2646+/-365; P<0.05, respectively).

CONCLUSION

Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery, with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when intraluminal processing is necessary for efficient digestion.

摘要

目的

研究择期腹主动脉瘤（AAA）修复手术后患者的远端小肠动力和脂质吸收情况。

方法

对9例AAA修复手术后患者（年龄35 - 78岁；体重指数（BMI）范围：23 - 36 kg/m²）和7例健康对照者（年龄20 - 50岁；BMI范围：21 - 29 kg/m²）进行研究。在禁食和肠内喂养（能全力）期间，连续进行长达72小时的远端小肠测压。分析记录的小肠爆发活动的频率、起源、迁移长度和方向。在一部分患者术后第1天和第3天使用¹³C - 三油酸甘油酯呼气试验评估脂质吸收情况，并与健康对照者进行比较。受试者接受20分钟的十二指肠内输注50 mL混合有200 μL¹³C - 三油酸甘油酯的液体饲料。收集6小时的呼气末呼吸样本并分析¹³CO₂浓度。

结果

在禁食和喂养条件下，患者近端和远端小肠的爆发活动频率均高于健康受试者（P < 0.005）。患者中异常传播的爆发比例较高（71%异常），术后第3天开始趋于正常（25%异常）。术后第1天有7例患者、第3天有4例患者可获得脂质吸收数据。患者术后第1天的吸收量是健康对照者的一半（¹³CO₂曲线下面积1323±244 vs 2646±365；P < 0.05），到第3天降至健康对照者的五分之一（¹³CO₂曲线下面积470±832 vs 2646±365；P < 0.05）。