• No results found

Original Article Curative effect of transnasal ileus tube combined with early enteral nutrition and dachengqi decoction in early postoperative inflammatory ileus

N/A
N/A
Protected

Academic year: 2020

Share "Original Article Curative effect of transnasal ileus tube combined with early enteral nutrition and dachengqi decoction in early postoperative inflammatory ileus"

Copied!
7
0
0

Loading.... (view fulltext now)

Full text

(1)

Original Article

Curative effect of transnasal ileus tube combined with

early enteral nutrition and dachengqi decoction

in early postoperative inflammatory ileus

Nan Zhang, Zhen-Li Zhou, Ji-Liang Xie

Department of Gastrointestinal Surgery, Tianjin Nankai Hospital, Tianjin 300100, China

Received April 3, 2015; Accepted December 15, 2015; Epub February 15, 2016; Published February 29, 2016 Abstract: Objective: To explore the treatment strategies of early postoperative inflammatory small bowel obstruction (EPISBO). Methods: 35 cases of EPISBO patients, according to the different treatment methods, were retrospec-tively divided into traditional Western medicine treatment group (WM group) and the Integrative medicine treatment group (IM group); IM group, in addition to traditional therapy, used ileus tube combined with early enteral nutrition and Dachengqi Decoction for treatment. Results: In WM group, the change in abdominal circumference (5.31 ± 3.26 cm) before and after treatment was significantly lower than that in the IM group (10.84 ± 5.01 cm, P < 0.05); On day 1, the gastrointestinal decompression amount in IM group (1796.25 ± 346.78 ml) was significantly more than that in WM group (977.89 ± 386.7 ml, P < 0.05), but bowel sound recovery time (2.34 ± 0.71 d), obstruction remission time (3.05 ± 1.01 d) and the obstruction-free time (8.07 ± 2.89 d) were significantly shorter compared with WM group respectively (3.37 ± 1.28 d, 3.82 ± 1.45 d, 12.89 ± 7.25 d) (P < 0.05). Conclusion: The combined treatment of ileus tube, early enteral nutrition and Dachengqi Decoction was better than the traditional Western medicine treatment in early postoperative inflammatory small bowel obstruction.

Keywords: EPISBO, Ileus tube, enteral nutrition, integrative medicine, dachengqi decoction

Introduction

Early postoperative inflammatory ileus (EPII) refers to the situation of mechanical (dynamic) adhesive bowel obstruction caused by bowel wall edema and exudation within an early peri-od after peritoneal surgery (usually at 2 weeks postoperatively) as a result of operative trauma or peritoneal inflammation [1, 2]. Trauma ca- used by peritoneal surgery includes any bowel injury arising from the separation of extensi- ve bowel adhesions, long-term bowel exposure and other surgical manipulations. Peritoneal inflammation mainly includes aseptic inflam-mation caused by hemoperitoneum, peritoneal effusion or other reasons [3]. This type of bowel obstruction can be attributed to mechanical factors and also to intestinal motility disorder without concurrent strangulation. EPII is dis-tinct from other types of bowel obstruction in the following aspects [4]: EPII generally occurs within an early period after surgery (at 2 weeks postoperatively) despite the temporary

(2)

stly practiced in China [6]. The present study was an analysis of EPII cases treated at our hospital in the past 10 years, and the curative effect was discussed.

Materials and methods

Clinical data

Diagnostic criteria of EPII: (1) Prior history of abdominal surgery, especially repeated sur-gery: (2) Temporary recovery of bowel move-ment and resumption of diets after surgery, but followed by recurrent bowel obstruction with nausea, omitting, no flatus and defecation and no prominent abdominal pain; hard abdomen by physical examination with normal or weak-ened bowel sounds; (3) Imaging findings: ① Plain abdominal X-ray showing several liquid-gas interfaces; ② Abdominal CT showing in- complete bowel obstruction, extensive edema, thickening and adhesion of small bowel walls with effusion in the intestinal lumen and perito-neal exudates; residual contrast agent showing intestinal stenosis at different positions and of varying extent; ③ Abdominal color Doppler ul- trasound showing extensive intestinal adhe-sion, edema and thickening with poor bowel movement; ④ Urografin-based gastrointestinal (GI) angiography showing difficult passage and reflux of contrast agent through the small

bow-sease, paralytic ileus; (4) Severe basic diseas-es affecting the observation indicators, such as hematologic diseases, immunological diseas-es, late-stage tumors and history of radiothe- rapy and chemotherapy within 6 months; (5) Severe internal diseases, such as hepatic cir-rhosis, chronic kidney diseases, diabetes and severe pulmonary infection.

Criteria for cure: (1) Restoration of flatus and defecation; (2) No need for GI decompression; (3) No need for targeted medication (eg., hor-mones, somatostatin, traditional Chinese med-icine, and blood-activating agents); no abnor-mal physical signs; (4) No recurrent bowel ob- struction after resumption of diet; (5) Plain ab- dominal X-ray, abdominal B ultrasound, abdom-inal CT or GI angiography showing no abnor- malities.

Grouping

According to the inclusion and the exclusion criteria, 35 cases of EPII (16 males and 19 females, 50.81 ± 12.44 years old) treated at Tianjin Nankai Hospital from January to October 2014 were recruited.

[image:2.612.90.370.84.125.2]

All cases received conventional treatments, including GI decompression, PN therapy and administration of somatostatin and adrenal Table 1. General information of the two groups

Parameters WM group (n=19) IM group (n=16) T (X2) P

[image:2.612.92.373.162.264.2]

Age (y) 49.63 ± 14.23 51 ± 14.85 1.24 0.28 Sex (Male/female) 10/9 6/10 0.89 0.44

Table 2. Surgical approach of the two groups

Surgical approach WM group (n, %) IM group (n, %) t (X2) P

Enterodialysis 8 (42.1) 10 (62.5) 1.33 0.198 Small bowel resection and anastomosis 1 (5.3) 3 (18.7) 0.41 0.775 Acute suppurative appendicitis 3 (15.8) 2 (12.5) 0.77 0.624 Gastrointestinal perforation repair 1 (5.3) 2 (12.5) 1.48 0.088 Gynecological surgery 2 (10.6) 1 (6.3) 1.58 0.074 Surgery for colonic cancer 1 (5.3) 1 (6.3) 2.44 0.059

Table 3. Duration of bowel obstruction and number of previous surgeries

Parameters WM group IM group t P Duration (d) 8.63 ± 3.2 9.68 ± 3.62 0.75 0.784 Number of previous surgeries 2.34 ± 0.58 2.16 ± 0.87 0.48 0.871

els, thus indicating slow bow- el movement; (4) Mechanical bowel obstruction caused by reasons other than external and internal hernia, volvulus, intussusception, stomal steno-sis and late-stage tumors. Inclusion criteria: (1) 20 and 70 years old; (2) Complete clin-ical data; (3) Meeting the diag-nostic criteria for EPII; (4) Re- ceiving the treatment of soma-tostatin, adrenal cortical hor-mones and parenteral nutri-tion (PN) therapy.

[image:2.612.90.372.308.350.2]
(3)

cortical hormones. The cases were divided into 2 groups: western medicine treatment group (conventional treatments, including GI decom-pression, PN therapy and administration of somatostatin and adrenal cortical hormones.) and integrative medicine treatment group (con-ventional treatments, plus Dachengqi Deco- ction).

Observation indicators: (1) Time to the occur-rence of postoperative obstruction: The period from the day of surgery to the occurrence of obstruction (d); (2) Number of previous surger-ies; (3) Abdominal circumference at 24 h after GI decompression (cm); (4) GI decompression amount at 1-3 d after decompression (ml); (5) Time to the recovery of bowel sounds, relief of obstruction and removal of obstruction (d). The cases of the two groups did not show sig-nificant differences in surgical approach, occur-rence time of EPII and number of previous sur-geries. See Tables 1-3.

Treatments

Conventional treatments: (1) The cases were fasted from liquids and solids, and the electro-lytes and acid-base balance were maintained. (2) PN therapy: Nonprotein calories 105 KL/ kg·d, nitrogen feeding 0.15 g/kg·d, ratio of en-

ergy to nitrogen 150:1. 30-40% of nonprotein calories were provided by fat emulsion, and 60-70% by glucose (ivd, QD, 4-14 days). (3) Somatostatin: Octreotide, 0.1 mg, SC, Q8H, 4-10 days. (4) Adrenal cortical hormones: dexa-methasone, 5 mg, ivd, Q12H, 3-7 days.

Method of GI decompression: (1) Convention- al gastric tube decompression: For cases show-ing inflammatory bowel obstruction and with indwelling gastric tube, GI decompression was further carried out; for those that had the gas-tric tube removed or received no preoperative decompression, GI decompression was per-formed by inserting the gastric tube. (2) Tr- ansnasal ileus tube decompression: If the dr- ainage amount was below 400 ml and the abdominal symptoms were not mitigated or even aggravated after transnasal ileus tube decompression for 2-3 days, decompression was further carried out under the endoscope using three-channel two-balloon transnasal ileus tube (CREATE MEDIC). The picture of tr- ansnasal ileus tube is shown in Figure 1. (3) Method of the insertion of transnasal ileus tube.

The insertion was performed under the X-ray guidance. The decompression procedures were as follows: ① The endoscope was inserted to the horizontal part of duodenum or even fur-ther. Then the guide wire was inserted into the upper jejunum and the endoscope was with-drawn. The guide wire was let out transnasally. ② The tube was gently inserted into the upper jejunum using the guide wire. The ileus tube was advanced manually into the distal small bowels, and the tube entered the intestinal tract through peristalsis. Decompression was carried out simultaneously. ③ Urografin was injected for angiography, and the bowel dilation and obstruction were observed. Placing the front balloon to the site of obstruction, 10-15 ml of sterile distilled water was injected to cause the front balloon to expand. Then the guide wire was withdrawn. ④ The ileus tube was then inserted into the stomach and kept it slack there. The negative pressure aspirator was connected to the other end of the ileus tube for decompression.

Subsequent use of transnasal ileus tube: (1) GI angiography: After full decompression, Urog- rafin angiography was performed electively. The expanded balloon at the back could help prevent the dilution of the contrast agent in dis-Figure 1. Three-channel two-balloon ileus tube by

[image:3.612.90.290.72.218.2]

CREATE MEDIC.

Table 4. Therapeutic effect comparison be-tween the two groups

Group Therapeutic effect Total Effective rate Effective Ineffective

[image:3.612.91.288.295.346.2]
(4)

tal bowels and thus improve the accuracy of observation. (2) Nutrition infusion: After full decomposition, EN and Dachengqi Decoction were infused via the ileus tube to improve the treatment effect.

EN therapy and infusion of dachengqi decoc- tion at early stage: (1) EN in small quantity at the early stage: When the cases showed wa- tery stool after Urografin angiography, Nutrison Fiber was injected through the ileus tube (200 ml, QD, 4-14 days). (2) Traditional Chinese med-icine treatment: Dachengqi Decoction was used as the basic formulation with addition or deduction of traditional Chinese medicine her- bs based on syndrome differentiation. The me- dicine was prepared by Traditional Chinese Me- dicine Pharmacy of Tianjin Nankai Hospital and infused through the ileus tube (200 ml, QD, 3-7 days).

Statistical analyses

The measurement data were analyzed by chi-square test, and count data by independent samples t-test. SPSS17.0 software was used for all statistical analyses, and P < 0.0 was con-sidered as statistically significant.

Results

Treatment effect

Of 35 cases, 16 cases received treatment by ileus tube and 1 case failed. This case was transferred to other surgery and showed post-operative intestinal leakage. However, the case was finally transferred to other hospital after several surgeries that failed to improve the con-ditions. Among 19 cases receiving convention-al gastric tube decompression, 3 cases failed, and 2 of them showed intestinal fistula after secondary surgery. These 2 cases were im-

Changes of abdominal circumference in cases of the two groups at 24 h after GI decompres-sion: The abdominal circumference decreased much more significantly in IM groups. See Table 5. Those who accepted transnasal ileus tube treatment had an obvious change of abdominal circumference.

GI decompression amount in two groups: GI decompression amount increased consider-ably at 1 day and 2 day after surgery, and the differences were of statistical significance com-pared with WM group. IM group showed no sig-nificant difference in GI decompression amount at 3 day after surgery. See Table 6.

The cases in IM group had a much shorter time to the recovery of bowel sounds, relief of ob- struction and removal of obstruction compared with WM group, and the differences were of sta-tistical significance. See Table 7.

Pathological changes in EPII overall observa-tion: ① Extensive abdominal adhesion which was difficult to separate; ② Inflammatory ed- ema and thickening of bowel wall; ③ A large number of filamentous substances found dur-ing the separation of adhesion. Under the mi- croscope: submucosal edema and mucosal th- ickening of small bowels with fibrous tissue pro-liferation and inflammatory cell infiltration. Discussion

For those with poor effect of GI decompression, transnasal ileus tube was inserted to the small bowels for decompression. The GI decompres-sion amount and changes of abdominal circum-ference before and after decompression were observed. The results showed that the drain-age amount was obviously higher using trans-nasal ileus tube than that using ordinary gastric tube. The changes of abdominal circumference Table 5. Changes of abdominal circumference after surgery (cm)

[image:4.612.91.315.144.200.2]

WM group IM group t P Changes of abdominal circumference (cm) 5.31 ± 3.26 10.84 ± 5.01 4.57 0.019

Table 6. GI decompression of the two groups (ml)

WM group IM group t P 1 d 977.89 ± 386.7 1796.25 ± 346.78 8.465 0.005 2 d 931.57 ± 314.49 1683.12 ± 395.89 7.598 0.004 3 d 713.15 ± 306.34 764.37 ± 236.75 0.787 0.454

proved after conservative treatment. Abdo- minal closure was performed for the remain-ing 1 case without surgery. For this case, conservation treatment was adopted and the case was finally cured. See Table 4.

(5)

were more conspicuous and could be observed by naked eyes. The small bowels proximal to obstruction were effectively decompressed with the ileus tube directly reaching the lesion. Moreover, the effusion in the bowels was quick-ly drained through the ileus tube, which short-ened the time to alleviation and to bowel sound restoration. The findings prove that ileus tube is an effective method for decompression and the treatment for EPII.

Ileus tube needs to be further improved in the following aspects: (1) Ileus tube is designed with two balloons. The balloon at the front pre-vents the backflow of fluid, and the side holes at the proximal and distal end of the balloon absorb fluid from the small bowels proximal to obstruction. The balloon at the back has no side holes, and it is intended to prevent the backflow of the contrast agent; (2) The ileus tube also has an air supplement device, which is a capillary tube located on the inner wall of the suction tube. As the suction proceeds at negative pressure, a small amount of air will constantly enter the intestinal lumen. Mean- while, a too large negative pressure is prevent-ed in the small bowels, and the tube will not be attached to the wall [29].

In addition, the ileus tube cannot only achieve decompression, but also selective enterogra-phy along with the administration of EN and Dachengqi Decoction.

After full decompression, selective angiograph-ic examination of GI can be performed. The bal-loon at the back is expanded by air to reach the size comparable to the inner diameter of the small bowel. The backflow of the contrast agent Urografin is prevented by the expanded balloon so that the contrast agent only goes into the distal small bowels. The localized high concen-tration of the contrast agent makes it easier to observe the morphology and movement of the bowels and the changes of the intestinal lumen.

motility can be given via the ileus tube, for example, EN and Dachengqi Decoction in this study. Thus ileus tube can be used for other treatment purposes besides decompression. We have demonstrated the value of ileus tube in the diagnosis and further treatment of EPII. According to literature, the ileus tube is most suitable for simple adhesive bowel obstruction, especially EPII [30]. We believe that bowel wall edema and exudation in EPII are exactly the indications of decompression using ileus tube. With an innovative and practical design, ileus tube brings new solution for non-surgical treat-ment and diagnosis of EPII.

Doctors of traditional Chinese medicine believe that EPII is caused by the blockage of qi flow in the bowels and viscera, to which the method of dispelling interior pathogenic factors and pur-gation applies. The time to achieve the allevia-tion of bowel obstrucallevia-tion was obviously short-ened in those treated by Dachengqi Decoction. We propose the action mechanism as follows: (1) Enhancing and regulating GI movement; (2) Killing and deactiving the endotoxins in GI tract: (3) Maintaining the normal functions of “intesti-nal barrier” and the important organs such as liver, kidney and lung; (4) Synergistic with west-ern medicines as blood-activating and stasis-resolving medicine; (5) Reducing the over-pro-duction of cytokines and hence preventing ex- cessive immune response; (6) Improving micro-circulation and increasing blood flow.

[image:5.612.91.371.96.152.2]

EPII can be effectively treated by modern medi-cine, and traditional Chinese medicine also has much to offer. The cases in our study were fur-ther treated by Dachengqi Decoction and EN in small quantity after decompression using ileus tube, and the curative effect was satisfactory. However, the sample size was small, and there was a lack of detailed observation and an indi-cator system for curative effect evaluation in our retrospective study. In the future, prospec-tive trials can be performed for an objecprospec-tive Table 7. Time to recovery of bowel sounds, relief of obstruction

and removal of obstruction in the two groups (d)

WM group IM group t P Time to recovery of bowel sounds 3.37 ± 1.28 2.34 ± 0.71 3.23 0.028 Time to relief of obstruction 3.82 ± 1.45 3.05 ± 1.01 3.14 0.030 Time to removal of obstruction 12.89 ± 7.25 8.07 ± 2.89 2.89 0.047

(6)

and quantitative analysis by experimental me- thod.

Acknowledgements

This work was supported by the Tianjin Muni- cipal Administration of traditional Chinese Me- dicine Foundation, 13041.

Disclosure of conflict of interest None.

Address correspondence to: Dr. Ji-Liang Xie, De- partment of Gastrointestinal Surgery, Tianjin Nan- kai Hospital, Changjiang Road 6#, Tianjin Nankai District, Tianjin 300100, China. Tel: +86+022-2743- 5252; E-mail: xiejllj@163.com

References

[1] Li JT. Understanding the characteristics of ear-ly postoperative inflammatory intestinal ob-struction. Chinese Journal of Practical Surgery 1998; 18: 387-388.

[2] Xiao HQ, Tang WB and Zeng SQ. Early postop-erative inflammatory intestinal obstruction in 42 treatment experience. The Journal of Prac-tical 2002; 18: 759-760.

[3] Zhu WM, Li N, Li JS, Yin L, Ren JA, Gu J, Jiang J, Wang SH and Wang XB. Early postoperative in-flammatory ileus. Chinese Journal of Practical Surgery 2002; 22: 219-220.

[4] Li YS and Li JS. Another theory of early postop-erative inflammatory intestinal obstruction. Chinese Journal of Practical Surgery 2006; 26: 38-39.

[5] Hayanga AJ, Bass-Wilkins K and Bulkley CB. Current management of small-bowel obstruc-tion. Adv Surg 2005; 39: 1-33.

[6] Pickle man J and Lee RM. The management of patients with suspected early postoperative small obstruction. Am Surg 1989; 2: 216-219. [7] Liu JY, Zeng GX, Zheng YB, Ran YX and Dai LH.

Traumatic intestinal adhesion formation in the process of peritoneal morphological observa-tion of organizaobserva-tion change. China Stereology and Image Analysis 2003; 8: 97-10.

[8] Philips RK and Dadlley HA. The effect of tetra-cycline lavoge and trauma on visceral and pa-rietal peritoneal ultrastructure and adhesion formation. Br J Surg 1984; 71: 537-9.

[9] Yang HM, Zheng SS, Lin SQ, Zhong FB, Qian J and Wu JF. Strong acid potential water re-search on the effects of abdominal cavity per-fusion of abdominal cavity adhesion. Chinese Journal of Experimental Surgery 2003; 20: 728-729.

[10] Wan XM, Sun XB, Xiao R, Yu NZ and Chen WG. Salvia miltiorrhiza prevention of epidural

adhe-sion of histological and ultrastructural study. Acta Acad Med Jiangxi 2004; 44: 78-79. [11] Stewart RM, Page CP, Brender J, Schwesinger

W and Eisenhut D. The incidence and risk of early postoperative small bowel obstruction. A cohort study. Am J Surg 1987; 154: 643-647. [12] Pickleman J and Lee RM. The management of

patients with suspected early postoperative small-bowel obstruction. Ann Surg 1989; 210: 216-21.

[13] Tortella BJ, Lavery RF, Chandrakantan A and Medina D. Incidence and risk factors for early small bowel obstruction after celiotomy for penetrating abdominal trauma. Am Surg 1995; 61: 956-958.

[14] Yin L, Li JS, Li N, Li LT and Chao JM. Early in-flammatory intestinal obstruction after abdom-inal surgery. Journal of Nanjing University 1997; 33: 32-36.

[15] Zhu WM and Li N. The diagnosis and treatment of early postoperative inflammatory intestinal obstruction. Chinese Journal of Practical Sur-gery 2000; 20: 456-458.

[16] Gong JF, Zhu WM, Li N and Li JS. Hormones and nutritional support joint treatment of early postoperative inflammatory intestinal obstruc-tion. Chinese Journal of General Surgery 2005; 20: 257-258.

[17] Jiang CC, LI SQ and Ren JL. Oral generic shad-ow meglumine in treatment of adhesive is not complete a prospective study of small intesti-nal obstruction. Chinese Jourintesti-nal of General Surgery 1999; 14: 157.

[18] Yang LH, Tang SC and Zou ZJ. Early postopera-tive inflammatory intestinal obstruction the treatment of oral generic shadow meglumine analysis. The Chinese Modern Journal of Sur-gery 2009; 6: 109-110.

[19] Zhang DJ. Peritoneal lavage in the treatment of early postoperative inflammatory ileus clinical observation. Chin J Mod Drug Appl 2008; 2: 35-36.

[20] Li R. Large bearing gas tonga taste treatment of 34 cases of early postoperative inflamma-tory intestinal obstruction. Chinese and West-ern Medicine Combined with Surgical Maga-zine in China 2007; 13: 129-130.

[21] Wu Y. Combine traditional Chinese and west-ern medicine in the treatment of early postop-erative inflammatory intestinal obstruction. Theory and Practice of Medicine 2008; 21: 1300-1301.

(7)

[23] Ren Y and Bao T. Traditional Chinese medicine retention enema in the treatment of early post-operative inflammatory intestinal obstruction 51 cases analysis. Chinese Journal of Misdiag-nostics 2006; 6: 2987-2988.

[24] Zhang JH, Liu B, Zhang YL and Zheng YQ. Large doses of mirabilite topical treatment the clini-cal effect of the treatment of early postopera-tive inflammatory intestinal obstruction. Jour-nal of Gannan Medical College 2007; 7: 561-562.

[25] LW Gemmell and C Rincon. Anaesthetic man-agement of intestinal obstruction. British Jour-nal of Anaesthesia 2001; 5: 138-14.

[26] Shang D, Bi W, Liang GG, Wang CM, Zhang SL, Zhang QK, Yu Y, Luo P and Qi QH. Ileus tube in an application in the treatment of acute intes-tinal obstruction. The Tenth Session of The Na-tional General Surgery with TradiNa-tional Chinese and Western Academic Progress and Pancre-atic Biliary Diseases Proceedings Classes 2006; 140-147.

[27] Henne-Bruns D and Lohnert M. Current status of diagnosis and nonoperative therapy of small bowel ileus. Chirurg 2000; 71: 503-509. [28] Li PS, Gao P, Xiao FL and Zhang GQ. Ileus tube

application in the treatment of early postoper-ative inflammatory intestinal obstruction in the abdomen. Journal of Clinical Surgery 2007; 15: 186-187.

[29] Liang GG, Bi D, Zhang SL and Zheng FJ. Ileus tube treatment of intestinal obstruction, 36 cases report. Chinese and Western Medicine Combined with Surgical Magazine in China 2006; 12: 191-193.

[30] Sakakibara Takumi, Harada Akio and Ishikawa Tadao. Significance of Long Tube Management and Timing of Surgical Operation for Conserva-tive Treatment of Adhesion Ileus. Japanese Journal of Gastroenterological Surgery 2005; 38: 1414-1419.

[31] Li JS. Nutritional support is applied in gastroin-testinal surgical experience. The Chinese Gen-eral Surgery 2000; 15: 172-173.

[32] Wilmore DW. Catabolic illness strategies for enhancing recovery. New J Med 1991; 325: 695.

[33] Wilmore DW. Rhoads lecture. The practice of clinical nutrition: how to prepare for the future. JPEN J Parenter Enteral Nutr 1989; 13: 337-43.

[34] Huang DP, Fan LD, Liang MQ, Huo H, Zhang J and Cai W. Gastrointestinal tract after 6 hours of enteral nutrition support in clinical research. Enteral Nutrition 1999; 6: 63-65.

[35] Ren ZQ, Ding W and Lu K. Enteral nutrition to prevent gastrointestinal dysfunction after ab-dominal surgery clinical studies. Chin J Prim Med Pharm 2003; 10: 1230-1231.

[36] Li JS. Enteral nutrition-preferred way of surgi-cal clinisurgi-cal support. Chinese Journal of Clinisurgi-cal Nutrition 2003; 11: 171-172.

Figure

Table 1. General information of the two groups
Figure 1. Three-channel two-balloon ileus tube by CREATE MEDIC.
Table 6. GI decompression of the two groups (ml)
Table 7. Time to recovery of bowel sounds, relief of obstruction and removal of obstruction in the two groups (d)

References

Related documents

Subramaninan (2010) declared that in glass fibre reinforced polypropylene leaf springs, the joint strength can be increased by decreasing the clearance between fastener and

For a Low supply voltage and High frequency range of operation, the delay line structure can be obtained by using a current starved delay cell or differential delay cell using

(2019) El VPH y el cáncer cervical en el Perú: las diferencias de accesibilidad entre las mujeres de las zonas rurales y urbanas / HPV and cervical cancer in Peru: The differences

Herein, we report that transgenic mice forced to express FGF9 in prostate epithelial cells (F9TG) developed high grade prostatic intraepithelial neoplasia (PIN) in an expression

The review and case presented here is intended to highlight the following: (a) physician being aware that both NMS and SS can appear as overlapping syndrome and consider one of

Untersuchungen uber die verzerrung die Konformen Abbildun- gen des Einheitschreises zl&lt;l, die durch Funktionen, mit nicht werschwindender Ableifert geleifert werden, Leip.. On

The expression levels of P-gp and MRP1 in peripheral blood of patients with refractory epilepsy are significantly higher than those of normal subjects and epilepsy patients;

We first use a simple translation lemma for bounding average sensitivity in terms of noise sensitivity of a Boolean function and Theorem 1.3 to obtain the following bound.. Theorem