Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial
Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial
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DOI：
10.1503/cmaj.1041315
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发表时间：
2005-11-08
影响因子：
14.6
通讯作者：
Chen, WJ
中科院分区：
文献类型：
--
作者：
Chen, SC;Yen, ZS;Chen, WJ
背景资料：部分粘连性小肠梗阻的患者通常采用保守治疗，接受静脉补液，不经口。以前的研究表明，这种方法与更长的住院时间和延迟手术的风险增加有关。我们进行了一项随机对照试验，以观察标准保守治疗与口服泻药、促渗剂和促排剂相结合是否会减少随后手术干预的频率并缩短住院时间。方法：我们确定了2000年2月至2001年7月间收治的144例连续的粘连性部分小-将128名符合入选标准的患者随机分为对照组（静脉补液、鼻胃管减压和不经口）或干预组（静脉补液、鼻胃管减压和口服氧化镁、嗜酸乳杆菌和西甲硅油）。主要结果指标是梗阻不经手术成功治疗的患者数量和住院时间。我们还监测并发症和复发obligation.Results：在128例患者中，63例在对照组和65例在干预组，平均年龄分别为54.4（标准差[SD] 15.9）年和53.9（SD 16.3）年。大多数患者为男性。干预组比对照组有更多的患者在没有手术的情况下成功治疗（59 [91%] v. 48 [76%]，p=0.03;相对风险1.19，95%置信区间1.03-1.40）。对照组患者的平均住院时间显著长于干预组患者（4.2 [SD 2.7] v. 1.0 [SD 0.7]天，p
Background: Patients with partial adhesive small-bowel obstruction are usually managed conservatively, receiving intravenous hydration and nothing by mouth. Previous studies have suggested that this approach is associated with longer hospital stays and an increased risk of delayed surgery. We conducted a randomized controlled trial to see if combining standard conservative treatment with oral administration of a laxative, a digestant and a defoaming agent would reduce the frequency of subsequent surgical intervention and reduce the length of hospital stay.Methods: We identified 144 consecutive patients admitted between February 2000 and July 2001 with adhesive partial small-bowel obstruction and randomly assigned 128 who met the inclusion criteria to either the control group ( intravenous hydration, nasogastric-tube decompression and nothing by mouth) or the intervention group (intravenous hydration, nasogastric-tube decompression and oral therapy with magnesium oxide, Lactobacillus acidophilus and simethicone). The primary outcome measures were the number of patients whose obstruction was successfully treated without surgery and the length of hospital stay. We also monitored rates of complications and recurring obstructions.Results: Of the 128 patients, 63 were in the control group and 65 in the intervention group; the mean ages were 54.4 (standard deviation [SD] 15.9) years and 53.9 (SD 16.3) years respectively. Most of the patients were male. More patients in the intervention group than in the control group had successful treatment without surgery (59 [91%] v. 48 [76%], p=0.03; relative risk 1.19, 95% confidence interval 1.03-1.40). The mean hospital stay was significantly longer among patients in the control group than among those in the intervention group (4.2 [SD 2.7] v. 1.0 [SD 0.7] days, p