胃肠道减压对老年粘连性小肠梗阻治疗必要性倾向评分匹配研究OA
Propensity score matching study on the necessity of gastrointestinal decompression in the treatment of adhesive small bowel obstruction in older patients
目的 比较胃肠道减压与无减压对老年人粘连性小肠梗阻患者的保守治疗效果.方法 回顾性分析305例2016年1月至2024年12月北京大学第一医院急诊科及普通外科接治的老年粘连性小肠梗阻患者临床资料.根据初始干预是否包含胃肠道减压分为无减压组(164例)和减压组(141例).两组均接受基础治疗(包括禁食禁饮、补液支持治疗),减压组加用导管进行胃肠道减压.将减压组与无减压组患者1︰1进行倾向性评分匹配.主要观察指标为治疗3 d内早期进食恢复情况,次要指标包括实际进食恢复情况,吸入性肺炎、中转手术、死亡发生情况.结果 共纳入患者305例,男178例,女127例,年龄71.0(65.0,78.0)岁.53.8%患者(164/305)初始拒绝接受胃肠道减压治疗.将两组基线资料1︰1匹配后,每组纳入104例患者资料进行分析.无减压组和减压组3 d内进食恢复率分别为65.4%(68/104)比42.3%(44/104)(P=0.001),实际进食恢复时间分别为3.0(2.0,4.0)d比4.0(3.0,5.0)d(P=0.002);总体进食恢复率分别为100.0%(104/104)比99.0%(103/104),吸入性肺炎发生率分别为1.9%(2/104)比2.9%(3/104),中转手术率1.0%(1/104)比2.9%(3/104),死亡率0(0/104)比1.0%(1/104),差异均无统计学意义(P均>0.05).针对早期肠梗阻恢复的多因素 Cox比例风险回归模型分析结果显示,无减压治疗能更早促进饮食恢复(HR=0.454,95%CI:0.299～0.689).结论 在老年人粘连性小肠梗阻的治疗过程中,无胃肠减压手段可实现早期恢复饮食目标,并未增加肺炎、死亡事件和中转手术风险.
Objective To compare the clinical efficacy of gastrointestinal decompression versus no decompression in the conservative management of older patients with adhesive small bowel obstruction(ASBO).Methods A retrospective cohort study was conducted,enrolling 305 older patients with ASBO admitted to the emergency surgery and general surgery departments of our hospital from January 2016 to December 2024.Based on the initial intervention,patients were divided into a non-decompression group(164 cases)and a decompression group(141 cases).Both groups received standard supportive care(including fasting,intravenous fluid resuscitation),while the decompression group underwent additional catheter-based gastrointestinal decompression.Propensity score matching(1︰1 ratio)was performed to balance baseline characteristics between the two groups.Primary outcomes included early feeding recovery within 3 days.Secondary outcomes encompassed the incidence of the actual time to dietary recovery,aspiration pneumonia,conversion to surgery and mortality.Results A total of 305 patients were included,178 males and 127 females,aged 71.0(65.0,78.0)year old.53.8%of patients(164/305)initially refused to accept gastrointestinal decompression treatment.After 1︰1 matching of the two baseline datasets,each group included 104 patients for analysis.The three-day feeding recovery rates in the decompression-free group and decompression group were 65.4%(68/104)vs 42.3%(44/104)(P=0.001),with actual feeding recovery times of 3.0(2.0,4.0)days versus 4.0(3.0,5.0)days(P=0.002).The overall feeding recovery rates were 100.0%(104/104)vs 99.0%(103/104).The incidence of aspiration-related pneumonia was 1.9%(2/104)vs 2.9%(3/104),with transfer surgery rates at 1.0%(1/104)vs 2.9%(3/104),and mortality rates at 0(0/104)vs 1.0%(1/104).No statistically significant differences were observed on the primary outcome and three secondary outcomes above(all P>0.05).For early intestinal obstruction recovery within 3 days,multivariate Cox regression analysis showed that no decompression therapy could promote dietary recovery earlier(HR=0.454,95%CI:0.299-0.689).Conclusions In the treatment of elderly patients with adhesive small bowel obstruction,the early goal of diet can be achieved without gastrointestinal decompression,and there is no increase in pneumonia,risk of death and risk of conversion to surgery.
王洪波;郭涛;白冲;刘斯
北京大学第一医院急诊科,北京 100034北京大学第一医院急诊科,北京 100034潍坊市人民医院耳鼻喉科,山东 潍坊 261041北京大学第一医院急诊科,北京 100034
老年人粘连性小肠梗阻胃肠道减压保守治疗
ElderlyAdhesive small bowel obstructionGastrointestinal decompressionConservative treatment
《中国医学前沿杂志（电子版）》 2026 (2)
44-50,7
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