高渗盐水对上消化道手术患者术后并发症的影响。

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery.

作者信息

Hong Siqi, Shang Qingjuan, Geng Qiankun, Yang Yang, Wang Yan, Guo Chunbao

机构信息

Department of neurology, Children's Hospital, Chongqing Medical University, Chongqing Department of Pathology, Linyi People's Hospital, Linyi, Shandong province Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital Department of Neonatology, Yongchuan Hospital, Chongqing Medical University Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.

出版信息

Medicine (Baltimore). 2017 Mar;96(12):e6121. doi: 10.1097/MD.0000000000006121.

DOI:10.1097/MD.0000000000006121

PMID:28328800

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5371437/

Abstract

The aim of this study was to explore the impact of 3% hypertonic saline (HS) intragastric administration for patients who underwent upper gastrointestinal surgery.During the postoperative period, 3% HS has been suggested as a means to improve the intestinal edema and reduce gastrointestinal complications.The medical records of 111 patients with HS intragastric administration following upper gastrointestinal surgery and 268 patients, served as control, were reviewed retrospectively. Propensity score matching was performed to adjust for selected baseline variables. Clinical outcomes, including early gastrointestinal function recovery, postoperative complications, and length of hospital stay, were compared according to the HS intragastric administration or not.HS intragastric administration was associated with prompt postoperative gastrointestinal function recovery, including first flatus (risk ratio [RR], 1.32; 95% confidence interval [CI], 0.89-1.65; P = 0.048) and feeding within 3 postoperative days (RR (95% CI), 0.57 (0.49-0.77); P = 0.036). Early ileus occurred in 25 of 108 patients with HS treatment versus 36 of 108 patients without HS treatment (RR (95% CI), 1.43 (0.63-2.15); P = 0.065). The patients with HS experienced a lower overall postoperative complication (odds ratio [OD] 0.57; 95% CI, 0.33-1.09; P = 0.063), including trend toward a decrease for infectious complications (15[13.9] vs 23[21.3]; P = 0.11; OD, 0.59; 95% CI, 0.29-1.22). There was a decreased incidence of anastomotic leakage (1[0.9] vs 7[6.5]; P = 0.033) and postoperative ileuas (5[4.6%] vs 11[10.2%]; P = 0.096) in the HS administration patients.Our study demonstrated beneficial postoperative clinical effects of HS intragastric administration in patients who had undergone upper gastrointestinal surgery, such as prompt postoperative gastrointestinal function recovery and reduced overall postoperative complications, which may be attributed to a reduced intestinal edema.

摘要

本研究旨在探讨3%高渗盐水（HS）胃内给药对接受上消化道手术患者的影响。在术后期间，3%高渗盐水被认为是改善肠道水肿和减少胃肠道并发症的一种方法。回顾性分析了111例上消化道手术后接受HS胃内给药患者和268例作为对照患者的病历。进行倾向评分匹配以调整选定的基线变量。根据是否进行HS胃内给药比较临床结局，包括早期胃肠功能恢复、术后并发症和住院时间。HS胃内给药与术后胃肠功能迅速恢复相关，包括首次排气（风险比[RR]，1.32；95%置信区间[CI]，0.89 - 1.65；P = 0.048）和术后3天内进食（RR（95%CI），0.57（0.49 - 0.77）；P = 0.036）。108例接受HS治疗的患者中有25例发生早期肠梗阻，而108例未接受HS治疗的患者中有36例发生（RR（95%CI），1.43（0.63 - 2.15）；P = 0.065）。接受HS治疗的患者术后总体并发症较低（优势比[OD]0.57；95%CI，0.33 - 1.09；P = 0.063），包括感染性并发症有下降趋势（15[13.9%]对23[21.3%]；P = 0.11；OD，0.59；95%CI，0.29 - 1.22）。HS给药患者吻合口漏（1[0.9%]对7[6.5%]；P = 0.033）和术后肠梗阻（5[4.6%]对11[10.2%]；P = 0.096）的发生率降低。我们的研究表明，HS胃内给药对上消化道手术患者术后具有有益的临床效果，如术后胃肠功能迅速恢复和术后总体并发症减少，这可能归因于肠道水肿减轻。