“非短肠综合征”：回肠造口患者的潜在健康问题。

The 'not so short-bowel syndrome': potential health problems in patients with an ileostomy.

机构信息

NIHR BRC Nutrition and Lifestyle, University Hospital Southampton, Southampton, UK.

出版信息

Colorectal Dis. 2013 Sep;15(9):1154-61. doi: 10.1111/codi.12252.

DOI:10.1111/codi.12252

PMID:23602060

Abstract

AIM

The study aimed to determine whether an ileostomy compromises nutritional, hydration and electrolyte status and bone mineral density.

METHOD

Body weight, body mass index (BMI) and fat and lean body mass (LBM) were measured in 60 patients with an ileostomy [14 small-bowel resection (SBR); 46 non-small-bowel resection (NSBR)] and in 60 age- and sex-matched normal controls. Measurement of plasma sodium, potassium, calcium, magnesium, urea and creatinine and 24-h urinary output of water, Na, K, Ca and Mg was made in 45 NSBR and 14 SBR ileostomists and in all the controls. Forty-six NSBR and 13 SBR ileostomists had bone mineral density (BMD) measurements of lumbar spine (LS) and femoral neck (FN).

RESULTS

The body weight of ileostomists was less than controls [median 67.8 (36.4-115.1) vs 77.7 (48.0-103.3) kg; P < 0.05]. BMI was also less [25.0 (14.3-43.0) vs 27.3 (20.2-32.2) kg/m(2) ; P < 0.05] with a lower LBM [47.8 (19.3-73.0) vs 52.9 (34.0-73.8) kg; P < 0.05]. The 24-h urinary output of the ileostomists was lower than for controls [1380 (430-4690) vs 2000 (840-4440) ml/24 h; P < 0.05] suggesting some degree of dehydration. In 62.7% of ileostomists 24-h urinary Na excretion was < 100 mmol/day vs 16.7% of controls, and ileostomists with lower urinary Na were more likely than ileostomists with normal Na excretion to have a low BMI [23.9 (14.3-33.0) vs 28.4 (16.6-43.0) kg/m(2) ; P < 0.001] and LBM [44.1 (19.3-73.0) vs 59.5 (36.6-67.9) kg; P < 0.001]. The respective 24-h output of Ca was [2.2 (0-6.1) vs 4.7 (0-13) mmol; P < 0.001] and Mg was [2.0 (0-13.7) vs 3.9 (1.2-5.4) mmol; P < 0.001], and BMD Z-score LS was -0.15 (-2.0 to 5.2) vs 0.3 (-2.5 to 2.1), Z-score FN -0.5 (-1.9 to 3.1) vs 0.2 (-1.2 to 1.4), both P < 0.05.

CONCLUSION

Patients with an ileostomy tend to have low body weight, BMI, LBM and BMD. They also tend to have low urine volumes, and some are depleted of Na, Ca and Mg. Abnormalities are greater in those with a lower urinary Na and measuring this will identify ileostomists at risk of Na depletion who will be benefitted by Na supplements.

摘要

目的

研究旨在确定回肠造口术是否会影响营养、水合状态和电解质以及骨矿物质密度。

方法

对 60 例回肠造口术患者（14 例小肠切除术[SBR]；46 例非小肠切除术[NSBR]）和 60 例年龄和性别匹配的正常对照组进行了体重、体重指数（BMI）和脂肪及瘦体重（LBM）的测量。45 例 NSBR 回肠造口术患者和 14 例 SBR 回肠造口术患者以及所有对照组进行了血浆钠、钾、钙、镁、尿素和肌酐的测量以及 24 小时尿液水、Na、K、Ca 和 Mg 的排泄量。46 例 NSBR 回肠造口术患者和 13 例 SBR 回肠造口术患者进行了腰椎（LS）和股骨颈（FN）的骨矿物质密度（BMD）测量。

结果

回肠造口术患者的体重低于对照组[中位数 67.8（36.4-115.1）vs 77.7（48.0-103.3）kg；P<0.05]。BMI 也较低[25.0（14.3-43.0）vs 27.3（20.2-32.2）kg/m²；P<0.05]，LBM 较低[47.8（19.3-73.0）vs 52.9（34.0-73.8）kg；P<0.05]。回肠造口术患者的 24 小时尿液排出量低于对照组[1380（430-4690）vs 2000（840-4440）ml/24 h；P<0.05]，提示存在一定程度的脱水。62.7%的回肠造口术患者 24 小时尿 Na 排泄量<100mmol/天，而对照组为 16.7%，Na 排泄量较低的回肠造口术患者更有可能 BMI[23.9（14.3-33.0）vs 28.4（16.6-43.0）kg/m²；P<0.001]和 LBM[44.1（19.3-73.0）vs 59.5（36.6-67.9）kg；P<0.001]较低。相应的 24 小时 Ca 排出量[2.2（0-6.1）vs 4.7（0-13）mmol；P<0.001]和 Mg 排出量[2.0（0-13.7）vs 3.9（1.2-5.4）mmol；P<0.001]，以及 LS 的 BMD Z 分数为-0.15（-2.0 至 5.2）vs 0.3（-2.5 至 2.1），FN 的 BMD Z 分数为-0.5（-1.9 至 3.1）vs 0.2（-1.2 至 1.4），均 P<0.05。