*Department of Surgery, University of Auckland, Auckland, New Zealand; and †Colorectal Unit, Department of Surgery, Auckland District Health Board, Auckland, New Zealand.
Ann Surg. 2015 Jul;262(1):23-30. doi: 10.1097/SLA.0000000000001062.
To investigate the therapeutic value of Gastrografin in shortening duration of prolonged postoperative ileus (PPOI) after elective colorectal surgery.
Gut wall edema is central to the pathogenesis of PPOI. Hyperosmotic, orally administered, water-soluble contrast media such as Gastrografin are theoretically capable of mitigating this edema.
A double-blinded, placebo-controlled, randomized trial was conducted. Participants were allocated to receive 100 mL of Gastrografin (Exposure Group) or flavored distilled water (Control Group) administered enterally. Other aspects of management were standardized. Resolution of PPOI was assessed 12-hourly.
Eighty patients were randomized equally, with 5 in the Exposure Group and 4 in the Control Group excluded from analysis. Participants were evenly matched at baseline. Mean duration of PPOI did not differ between Exposure and Control Groups (83.7 vs 101.3 hours; P = 0.191). When considering individual markers of PPOI resolution, Gastrografin did not affect time to resolution of nausea and vomiting (64.5 vs 74.3 hours; P = 0.404) or consumption of oral diet (75.8 vs 90.0 hours; P = 0.297). However, it accelerated time to flatus or stool (18.9 vs 32.7 hours; P = 0.047) and time to resolution of abdominal distension (52.8 vs 77.7 hours; P = 0.013). There were no significant differences between groups in nasogastric output; analgesia, antiemetic, or fluid requirement; complications; or length of stay.
Gastrografin is not clinically useful in shortening an episode of PPOI characterized by upper and lower gastrointestinal symptoms. It may however be of therapeutic benefit in the subset of PPOI patients who display lower gastrointestinal symptoms exclusively after surgery.
研究泛影葡胺缩短择期结直肠手术后术后迁延性肠麻痹（PPOI）持续时间的治疗价值。
肠壁水肿是 PPOI 的发病机制中心。理论上，口服高渗水溶性对比剂如泛影葡胺能够减轻这种水肿。
进行了一项双盲、安慰剂对照、随机试验。参与者被分配接受 100 毫升泛影葡胺（暴露组）或调味蒸馏水（对照组）肠内给药。其他管理方面标准化。每 12 小时评估一次 PPOI 的缓解情况。
80 名患者被平均随机分配，其中 5 名暴露组和 4 名对照组的患者被排除在分析之外。基线时，参与者的匹配情况均匀。暴露组和对照组的 PPOI 持续时间无差异（83.7 与 101.3 小时；P = 0.191）。考虑到 PPOI 缓解的个别标志物，泛影葡胺对缓解恶心和呕吐的时间（64.5 与 74.3 小时；P = 0.404）或口服饮食的摄入时间（75.8 与 90.0 小时；P = 0.297）没有影响。然而，它加速了放屁或排便的时间（18.9 与 32.7 小时；P = 0.047）和腹胀缓解的时间（52.8 与 77.7 小时；P = 0.013）。两组之间的鼻胃管引流量、镇痛、止吐和液体需求、并发症或住院时间无显著差异。
泛影葡胺在缩短以上下胃肠道症状为特征的 PPOI 发作方面没有临床意义。然而，它可能对手术后仅表现出下胃肠道症状的 PPOI 患者亚组有治疗益处。
