咀嚼口香糖加速腰椎后路融合术后患者 胃肠道功能恢复的临床观察

Chewing gum enhances bowel function recovery in patients after posterior lumbar fusion surgery

摘要:

目的：探究咀嚼口香糖能否加速腰椎后路融合术后患者胃肠道功能的恢复。方法：回顾性分析重庆医科大学附属第一医院骨科脊柱病区2016年1月至2016年9月收治的腰椎间盘突出症且行腰椎后路融合手术治疗的患者的临床资料，共65例，按术后是否咀嚼口香糖分为观察组和对照组。观察组患者（30例）于术毕麻醉清醒后6 h开始咀嚼益达无糖木糖醇口香糖，每4小时1次，每次2粒，每次至少咀嚼15 min，至肛门首次排气后改为每8小时1次，直至术后第5天；对照组患者（35例）术后不咀嚼口香糖，仅接受常规护理。2组患者术后均禁食，肛门排气后开始进食流质饮食，并逐步过渡到正常饮食。比较2组患者术后首次闻及肠鸣音时间，肛门首次排气时间、首次排便时间、住院时间、住院费用以及并发症等指标。结果：咀嚼口香糖能明显缩短患者术后首次闻及肠鸣音时间[（12.35±2.87） h vs. （17.10±2.59） h，t=-7.007，P=0.000]、肛门首次排气时间[（17.34±2.86） h vs. （24.12±3.18） h，t=-8.974，P=0.000]及首次排便时间[（51.89±5.16） h vs. （74.81±4.76） h，t=-18.612，P=0.000]，但2组患者的住院时间[（11.67±2.12） d vs. （12.03±2.33） d，t=-0.650，P=0.518]、住院费用[（66 554.13±16 325.18）元vs. （65 707.26±11 765.25）元，t=-0.493，P=0.809]及并发症发生率（10/30 vs. 12/35， ?字2=0.007，P=0.936）无统计学差异。结论：咀嚼口香糖可以加速腰椎后路融合术后患者胃肠道功能的恢复。上述结论尚需大样本、多中心的前瞻性研究来验证。

Abstract:

Objective：To determine whether chewing gum can enhance the recovery of bowel function in patients after posterior lumbar fusion（PLF） surgery. Methods：A retrospective comparative study was performed on 65 patients who were diagnosed with lumbar disc herniation and received PLF surgery between January 2016 and September 2016 in Department of Orthopedics in The First Affiliated Hospital of Chongqing Medical University. Thirty patients in the study group started chewing gum every 4 hours，2 grain every time，and at least for 15 minutes，3 hours after they were awaken of the anesthesia. When the first passage of flatus happened，the chewing frequency was increased to every 8 hours，until 5 days postoperative. While the other 35 patients in the control group chewed nothing. The time of first bowel sounds heard，the first passage of flatus，the first passage of defecation，and hospitalization，hospitalization ex－penses and complication were all recorded and analyzed. Results：Patients in the study group had less time of the first bowel sounds heard[（12.35±2.87） h vs. （17.10±2.59） h，t=-7.007，P=0.000]，the first passage of flatus[（17.34±2.86） h vs. （24.12±3.18） h，t= -8.974，P=0.000]，and the first passage of defecation [（51.89±5.16） h vs. （74.81±4.76） h，t=-18.612，P=0.000]. But no significant difference was found in hospitalization[（11.67±2.12） d vs. （12.03±2.33） d，t=-0.650，P=0.518]，hospitalization expenses[（66 554.13±16 325.18） yuan vs. （65 707.26±11 765.25） yuan，t=-0.493，P=0.809] and complication rate（10/30 vs. 12/35， ?字2=0.007，P=0.936） between the two groups. Conclusion：Chewing gum enhances the recovery of bowel function after PLF surgery. Large sample，multi-center prospective study are needed to verify this conclusion.