Section of Translational Anaesthesia and Surgery, Leeds Institute of Biological and Clinical Sciences, University of Leeds, Leeds, UK.
Colorectal Dis. 2018 Jun;20(6):536-544. doi: 10.1111/codi.13949.
Postoperative ileus (POI) is characterised by delayed gastrointestinal recovery and is common after colorectal surgery. Numerous strategies to optimise POI have been proposed but its management remains an unmet clinical need. This study aimed to characterise the duration and management of gastrointestinal recovery in patients undergoing elective colorectal surgery.
A snapshot, prospective, observational study was undertaken between November 2016 and January 2017 at 10 regional hospitals in the United Kingdom. Adult patients undergoing elective colorectal surgery with resection of bowel or reversal of stoma were included. Outcomes included time until return of gastrointestinal function, timing of nasogastric tube (NGT) insertion, uptake of targeted interventions and clinical outcomes. Data were validated for accuracy by independent investigators.
204 patients met the eligibility criteria. The median time for gastrointestinal recovery was 3 days (IQR 2-4); right-sided resections were associated with longer gastrointestinal recovery than left sided (4 days (2.75-5.25) vs 3 days (2-4); P = 0.002). The rate of NGT insertion was 22.5% at a median time of 4 (4-4.75) days. NGT insertion after vomiting was associated with a higher incidence of bronchopneumonia compared to early placement (13.3% vs 29.0%). Targeted interventions, such as chewing gum (4.4%), selective mu-receptor antagonists (1.0%) and pro-kinetic agents (13.7%) were infrequently used.
The average time to gastrointestinal recovery after elective colorectal surgery was three days. Late NGT insertion was associated with an increased incidence of bronchopneumonia. The clinical uptake of targeted interventions to improve gastrointestinal recovery was poor.
术后肠麻痹（POI）的特点是胃肠道恢复延迟，在结直肠手术后很常见。已经提出了许多优化 POI 的策略，但它的管理仍然是一个未满足的临床需求。本研究旨在描述择期结直肠手术患者胃肠道恢复的持续时间和管理。
在英国 10 家区域医院进行了一次快照式、前瞻性、观察性研究。纳入接受择期结直肠手术、肠切除或造口还纳的成年患者。结果包括胃肠功能恢复时间、鼻胃管（NGT）插入时间、目标干预措施的采用情况和临床结局。由独立研究者对数据进行准确性验证。
204 例患者符合入选标准。胃肠恢复的中位时间为 3 天（IQR 2-4）；右侧切除与左侧切除相比，胃肠恢复时间更长（4 天（2.75-5.25）比 3 天（2-4）；P=0.002）。NGT 插入率为 22.5%，中位时间为 4 天（4-4.75）。与早期放置相比，呕吐后插入 NGT 与支气管肺炎发生率较高相关（13.3%比 29.0%）。咀嚼口香糖（4.4%）、选择性 M 受体拮抗剂（1.0%）和促动力药物（13.7%）等靶向干预措施很少使用。
择期结直肠手术后胃肠道恢复的平均时间为 3 天。延迟插入 NGT 与支气管肺炎发生率增加相关。改善胃肠道恢复的靶向干预措施的临床应用率较低。
