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目的探讨小儿腹部外科急性胃肠功能衰竭的治疗方案。方法 2000年2月至2010年2月小儿腹部外科出现急性胃肠功能衰竭病人,给予胃肠减压,应用大黄促进胃肠蠕动,抑酸剂抑制胃酸分泌,胃肠道出血后行止血治疗,并进行改善微循环、控制感染、营养支持等处理。结果全部病例43例,死亡18例,死亡率41.86%。其中早期干预胃肠功能障碍23例,死亡6例,死亡率为26.09%;晚期干预组20例,死亡12例,死亡率为60.00%,两组比较,差异有统计学意义(χ2=5.05,P<0.05)。大黄组15例,死亡3例,死亡率为20.00%;非大黄使用组28例,死亡15例,死亡率为53.57%,两组比较,差异有统计学意义(χ2=4.52,P<0.05)。本组均有上消化道出血,胃内用止血药16例,3例死亡;单纯静脉应用立止血、抑酸剂等药27例,死亡15例,显示胃有出血时从胃内用药明显优于单纯静脉用药(χ2=5.59,P<0.05)。结论对小儿腹部外科危重症儿胃肠功能衰竭的早认识,早干预,采用胃肠减压、应用大黄、出现上消化道出血后应从胃管注入止血药等综合治疗措施,是降低病死率的关键。
Objective To investigate the treatment of acute gastrointestinal failure in pediatric abdominal surgery. Methods From February 2000 to February 2010, patients with acute gastrointestinal failure underwent abdominal surgery in children. Gastrointestinal decompression was given. Rhubarb was used to promote gastrointestinal motility. Inhibitor of gastric acid secretion by antacids and bleeding after gastrointestinal bleeding were treated by hemostasis. And to improve microcirculation, infection control, nutritional support and other treatment. Results All the cases were 43 cases, 18 died, the mortality rate was 41.86%. There were 23 cases of early gastrointestinal dysfunction and 6 cases of death, the mortality rate was 26.09%. In the late intervention group, 20 cases were killed and 12 cases died, the mortality rate was 60.00%. There was significant difference between the two groups (χ2 = 5.05, P <0.05). There were 15 cases in the rhubarb group and 3 cases died, the mortality rate was 20.00%. In non-rhubarb group, 28 cases were used and 15 cases died. The mortality rate was 53.57%. There was significant difference between the two groups (χ2 = 4.52, P <0.05) . The group had upper gastrointestinal bleeding, gastric hemostasis in 16 cases, 3 patients died; intravenous bleeding alone, antacids and other drugs in 27 cases, 15 patients died, showed gastric bleeding was significantly superior from the stomach In simple intravenous medication (χ2 = 5.59, P <0.05). Conclusion Early diagnosis and treatment of gastrointestinal failure in pediatric abdominal surgery patients with early intervention, gastrointestinal decompression, application of rhubarb, the emergence of upper gastrointestinal bleeding should be injected from the gastric tube hemostatic drugs and other comprehensive treatment measures to reduce mortality The essential.