数字减影血管造影下经鼻肠梗阻导管置入联合序贯肠内营养治疗对粘连性小肠梗阻患者的影响

Effect of DSA-guided transnasal intestinal obstruction catheterization combined with sequential enteral nutrition on patients with adhesive small bowel obstruction

摘要:

目的 探讨数字减影血管造影（DSA）下经鼻肠梗阻导管置入联合序贯肠内营养（EN）治疗对粘连性小肠梗阻患者的影响。方法 选取2024年2月—2025年8月邯郸市第一医院收治的98例粘连性小肠梗阻患者，随机分为对照组与观察组，各49例。对照组实施常规保守治疗与常规营养支持，观察组实施DSA下经鼻肠梗阻导管置入联合序贯EN治疗。比较两组临床疗效、症状与体征改善情况［腹胀腹痛缓解时间、恢复EN时间、恢复排气时间、恢复排便时间、24 h引流量、住院时间］、营养指标［血清白蛋白（Alb）、前白蛋白（PA）、血红蛋白（Hb）］、炎症因子［C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞计数（WBC）］、并发症发生情况。结果 观察组总有效率高于对照组（P <0.05）。观察组腹胀腹痛缓解时间、恢复EN时间、恢复排气时间、恢复排便时间及住院时间均短于对照组（P <0.05），24 h引流量少于对照组（P <0.05）。对照组与观察组治疗前Alb、PA、Hb比较，差异均无统计学意义（P >0.05）。观察组治疗后Alb、PA均高于对照组（P <0.05）。观察组治疗前后Alb、PA的差值均大于对照组（P <0.05）。对照组与观察组治疗前CRP、IL-6、WBC比较，差异均无统计学意义（P >0.05）。观察组治疗后CRP、IL-6、WBC均低于对照组（P <0.05）。观察组治疗前后CRP、IL-6、WBC的差值均大于对照组（P <0.05）。观察组并发症总发生率低于对照组（P <0.05）。结论 DSA下经鼻肠梗阻导管置入联合序贯EN可有效缓解粘连性小肠梗阻症状，促进肠功能恢复，改善营养与炎症状态，减少并发症，具有较高的临床应用价值。

Abstract:

Objective To investigate the effect of digital subtraction angiography (DSA)-guided transnasal intestinal obstruction catheterization combined with sequential enteral nutrition (EN) on patients with adhesive small bowel obstruction.Methods A total of 98 patients with adhesive small bowel obstruction admitted to our hospital from February 2024 to August 2025 were enrolled and randomly divided into a control group and an observation group, with 49 cases in each group. The control group received conventional conservative treatment and routine nutritional support, while the observation group received DSA-guided transnasal intestinal obstruction catheterization combined with sequential EN. Clinical efficacy, improvement of symptoms and signs [time to relief of abdominal distension and pain, time to recovery of EN, time to first flatus, time to first defecation, 24-hour drainage volume, and length of hospital stay], nutritional indicators [serum albumin (Alb), prealbumin (PA), hemoglobin (Hb) ], inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), white blood cell count (WBC) ], and the incidence of complications were compared between the two groups.Results The overall effective rate of the observation group was higher than that of the control group (P < 0.05). The time to relief of abdominal distension and pain, time to recovery of EN, time to recovery of flatus, time to recovery of defecation, and length of hospital stay in the observation group were shorter than those in the control group (P < 0.05), and the 24-hour drainage volume was less in the observation group than that in the control group (P < 0.05). There were no statistically significant differences in Alb, PA, and Hb levels between the control group and the observation group before treatment, as determined by t-test (P > 0.05). After treatment, Alb and PA levels in the observation group were higher than those in the control group (P < 0.05). The differences in Alb and PA levels before and after treatment in the observation group were greater than those in the control group (P < 0.05). There were no statistically significant differences in CRP, IL-6, and WBC levels between the control group and the observation group before treatment, as determined by t-test (P > 0.05). After treatment, CRP, IL-6, and WBC levels in the observation group were lower than those in the control group (P < 0.05). The differences in CRP, IL-6, and WBC levels before and after treatment in the observation group were greater than those in the control group (P < 0.05). The overall incidence of complications in the observation group was lower than that in the control group (P < 0.05).Conclusion DSA-guided transnasal intestinal obstruction catheterization combined with sequential EN can effectively relieve symptoms of adhesive small bowel obstruction, promote recovery of intestinal function, improve nutritional and inflammatory status, and reduce complications, showing high clinical application value.