Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
Am J Surg. 2019 Apr;217(4):689-693. doi: 10.1016/j.amjsurg.2018.08.003. Epub 2018 Aug 29.
Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems.
A prospective cohort of SBO patients was compared to a historical cohort of SBO patients after implementation of a SBO protocol using evidence-based guidelines and Omnipaque, a low-osmolar water soluble contrast. Patients without a history of abdominal surgery were excluded and data was collected through chart review.
Univariate analyses demonstrated a decrease in both LOS by 1.35 days and in the proportion of patients receiving surgery (37% vs 25%; p < 0.05). There was a decrease in time to surgery, rate of SBR, and rate of complications, yet an increase in readmission, although these findings were not statistically significant.
Utilizing an evidence-based SBO protocol can lead to shorter LOS and may result in fewer operations for adhesive SBO patients.
小肠梗阻（SBO）是一种常见病症，会导致大量患者住院和手术。在医院系统中，尚未广泛实施针对粘连性 SBO 患者的标准化治疗。
采用基于循证指南的 SBO 方案，使用欧乃派克（一种低渗水溶性造影剂），对 SBO 患者进行前瞻性队列研究，并与 SBO 方案实施前的历史队列进行比较。排除既往有腹部手术史的患者，并通过病历回顾收集数据。
单因素分析显示， LOS 缩短 1.35 天（p<0.05），手术患者比例降低（37% vs 25%）。手术时间、SBR 发生率和并发症发生率均有所下降，但再入院率有所上升，尽管这些差异无统计学意义。
采用基于循证医学的 SBO 方案可缩短 LOS，可能减少粘连性 SBO 患者的手术次数。
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