Singh G, Ram R P, Khanna S K
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Am Coll Surg. 1998 Aug;187(2):142-6. doi: 10.1016/s1072-7515(98)00154-9.
In our clinical setting, patients with perforative peritonitis are frequently malnourished. Immediate postoperative enteral feeding has been shown effective in reducing septic morbidity in patients with abdominal trauma. This study was designed to investigate the feasibility and efficacy of immediate postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis.
A prospective study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis. After laparotomy, patients were assigned randomly to a control or study group. The study group underwent a feeding jejunostomy and received enteral feeding from 12 hours postoperatively. A low-residue, milk-based diet was used. All patients underwent assessment for severity of sepsis and nutritional status at admission. Studies of nutritional status and nitrogen balance were repeated on days 4 and 7.
Forty-three patients (21 in the study group; 22 in the control group) were included. The two groups were comparable except for a higher sepsis score in the study group (p < 0.05). Patients in the study group achieved a positive nitrogen balance by the third postoperative day; patients in the control group remained in negative nitrogen balance throughout the study. Abdominal distention (four patients) required temporary withdrawal of feeding. Diarrhea occurred in four patients but was controlled easily. The mortality rate was similar in the control and study groups (18.2% versus 19.1%). The control group had a total of 22 septic complications, versus eight in the study group (p < 0.05).
Immediate postoperative feeding is feasible in patients with perforative peritonitis and reduces septic morbidity.
在我们的临床环境中，穿孔性腹膜炎患者常常营养不良。术后立即肠内喂养已被证明可有效降低腹部创伤患者的感染性发病率。本研究旨在调查术后立即肠内喂养在非创伤性肠穿孔和腹膜炎患者中的可行性和疗效。
对非创伤性肠穿孔和腹膜炎患者进行了一项为期1年的前瞻性研究。剖腹手术后，患者被随机分配至对照组或研究组。研究组进行空肠造口喂养，并于术后12小时开始接受肠内喂养。采用低残渣、以牛奶为基础的饮食。所有患者在入院时均接受了脓毒症严重程度和营养状况评估。在第4天和第7天重复进行营养状况和氮平衡研究。
纳入43例患者（研究组21例；对照组22例）。除研究组脓毒症评分较高外（p<0.05），两组具有可比性。研究组患者在术后第3天实现了正氮平衡；对照组患者在整个研究过程中一直处于负氮平衡状态。4例患者出现腹胀，需要暂时停止喂养。4例患者出现腹泻，但易于控制。对照组和研究组的死亡率相似（分别为18.2%和19.1%）。对照组共有22例感染性并发症，而研究组为8例（p<0.05）。
穿孔性腹膜炎患者术后立即喂养是可行的，并可降低感染性发病率。
