Smith C D, Sarr M G
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
JPEN J Parenter Enteral Nutr. 1991 May-Jun;15(3):328-31. doi: 10.1177/0148607191015003328.
We evaluated the incidence of clinically significant pneumatosis intestinalis and intestinal necrosis with the use of needle catheter jejunostomy in 217 consecutive patients who had undergone complicated abdominal operations or selected bariatric procedures. The needle catheter jejunostomy was used to deliver immediate postoperative nutrition, maintenance, and replacement fluids, and selected medications. In this group, no serious complications requiring surgical intervention were related to the use of needle catheter jejunostomies. Clinically significant pneumatosis intestinalis was encountered in two of 217 patients (1%). With the needle catheter jejunostomy in place, both patients improved rapidly when enteral feedings were discontinued and parenteral antibiotics were administered. None of the 217 patients developed ischemic intestinal necrosis. We conclude that 1) clinically significant pneumatosis is a rare complication of enteric feeding via needle catheter jejunostomy when the intrajejunal feeding is begun with a diluted, hypoosmolar solution with stepwise increases in osmolality, and 2) patients who do develop clinically significant pneumatosis (n = 2) seem to respond rapidly to a temporary stoppage of enteral feedings and administration of parenteral antibiotics.
我们评估了217例连续接受复杂腹部手术或特定减肥手术患者使用针导管空肠造口术时临床显著的肠壁积气和肠坏死的发生率。针导管空肠造口术用于术后立即提供营养、维持和补充液体以及特定药物。在该组中，未发现与使用针导管空肠造口术相关的需要手术干预的严重并发症。217例患者中有2例（1%）出现临床显著的肠壁积气。在留置针导管空肠造口术的情况下，停止肠内喂养并给予肠外抗生素后，这两名患者均迅速好转。217例患者中无一例发生缺血性肠坏死。我们得出结论：1）当空肠内喂养从稀释的低渗溶液开始并逐步增加渗透压时，临床显著的肠壁积气是通过针导管空肠造口术进行肠内喂养的罕见并发症；2）确实发生临床显著肠壁积气的患者（n = 2）似乎对暂时停止肠内喂养和给予肠外抗生素反应迅速。
