Cheadle W G, Vitale G C, Mackie C R, Cuschieri A
Ann Surg. 1985 Sep;202(3):361-6. doi: 10.1097/00000658-198509000-00014.
To determine the need for prophylactic nasogastric decompression following laparotomy and the influence of cimetidine, 200 consecutive patients who underwent major abdominal procedures were prospectively randomized into one of four limbs: no tube-placebo; no tube-cimetidine; tube-placebo; and tube-cimetidine. Patients were evenly distributed among these groups with respect to age, sex, alcohol and tobacco use, previous operations, and types of operations. There was significantly longer time until passage of flatus, bowel movement, and cessation of intravenous fluids in the tube group (p less than 0.05). Duration of postoperative stay increased from 11.4 to 14.1 days in the intubated patients (p less than 0.05). There was also significantly more pain with and frequency of swallowing, and nose/throat discomfort in the tube group. Nasogastric tubes reduced the incidence of vomiting from 28 in the no-tube group to 10 in the tube group (p less than 0.05), but most had only one or two episodes. Cimetidine did not affect either the incidence of vomiting or the duration of intubation, but was associated with a significant increase in pneumonias (p less than 0.05). Five patients without tubes initially, and seven patients with tubes had to have them inserted or replaced for vomiting or abdominal distention, which occurred equally in the placebo and cimetidine limbs. There were no cases of aspiration pneumonia, gastric dilatation, or wound dehiscence in the trial, and the four anastomotic leaks were divided equally between the tube and no-tube groups. The results indicated that prophylactic decompression was unnecessary in most patients and associated with increased morbidity and delayed return of gastrointestinal function. Cimetidine lowered nasogastric output on the first postoperative day (p less than 0.05), but did not prevent vomiting.
为了确定剖腹手术后预防性鼻胃减压的必要性以及西咪替丁的影响，200例接受腹部大手术的连续患者被前瞻性地随机分为四组之一：无管 - 安慰剂组；无管 - 西咪替丁组；置管 - 安慰剂组；置管 - 西咪替丁组。患者在年龄、性别、烟酒使用情况、既往手术史和手术类型方面在这些组中分布均匀。置管组在出现肠鸣、排便和停止静脉补液方面的时间明显更长（p < 0.05）。插管患者的术后住院时间从11.4天增加到14.1天（p < 0.05）。置管组吞咽时的疼痛和频率以及鼻/喉不适也明显更多。鼻胃管使呕吐发生率从无管组的28例降至置管组的10例（p < 0.05），但大多数患者只有一两次呕吐发作。西咪替丁既不影响呕吐发生率也不影响插管持续时间，但与肺炎显著增加有关（p < 0.05）。最初无管的5例患者和有管的7例患者因呕吐或腹胀不得不插入或更换鼻胃管，在安慰剂组和西咪替丁组中发生情况相同。试验中没有吸入性肺炎、胃扩张或伤口裂开的病例，4例吻合口漏在置管组和无管组中平分。结果表明，大多数患者无需预防性减压，且预防性减压与发病率增加和胃肠功能恢复延迟有关。西咪替丁在术后第一天降低了鼻胃管引出量（p < 0.05），但未能预防呕吐。
