因上腸系膜動脈阻塞大量小腸切除術後併發短腸症病患出院之營養照顧～個案報告

Nutritional Support for One Patient with Short Bowel Syndrome after Massive Small Bowel Resection Caused by SMA Occlusion~a Case Report

趙文綺(Wen-Chii Chao)

《東港安泰醫護雜誌》 12卷2期 (2006/06) Pp. 105-111

https://doi.org/10.7078/TSMHMNJ.200606.0105

摘要

短腸症候群(short bowel syndrome, SBS)是指腸道經大量切除後產生之各種代謝不平衡及營養素失調的症狀。而影響短腸症癒後的因素包括腸切除長度、腸切除位置及迴盲瓣是否存留等。大範圍的腸切除後，剩餘腸道對於失去的吸收區域會產生結構性及功能性的適應改變，時間可長達2年以上。報告病例在1999年12月因上腸系膜動脈(SMA)阻塞引發小腸大量壞死，進行迴腸全切除，部分空腸切除及空腸結腸吻合術，術後剩空腸70公分，住院期間使用全靜脈營養支持，出院後持續每月回診及進行營養評估。在體位測量方面，體重平均為46.2公斤（相當於74%理想體重）、體脂肪平均為5%、膽固醇平均為107mg/dL，三年回診期間，病患仍陸續有腹瀉情形產生，尤其在冬天更為明顯。目前並無相關文獻指出體脂肪及膽固醇過低對於身體之確實影響，但長期處於體重過輕之營養不良狀態顯著影響病患之體力、活動力及抵抗力。

關鍵字

短腸症候群 ； 全靜脈營養

並列摘要

Short bowel syndrome (SBS) is the complications of the metabolic and nutritional imbalance after massive resection of small bowel. The outcome of SBS depends on the resection length, location and whether the ileocecal valve is preserved. After massive loss of the small intestine, the residual bowel will pass through several stages of gradual adaptation of function and structure over two or more than two years. The case reported due to superior mesenteric artery (SMA) occlusion with small bowel necrosis received total resection of the ileum and the ileocecal valve, segmental resection of part of the jejunum, with 70cm proximal jejunum left and end-to-side jejnuocolostomy. During hospital stay, the patient received total parenteral nutrition (TPN) support. After discharge, the patient was routinely followed up at OPD for nutrition evaluation. In anthropometrics data, the body weight average is 46.2kg (about 74% ideal body weight), body fat average is 5% (normal range: 18-25%), blood cholesterol average is 107mg/dL. The patient still has diarrhea during past three years, especially in winter. There are just a few references discussed about the influences of low body fat and hypocholesteremia, however underweight actually affect the activity and immunity of this patient.

並列關鍵字

Short bowel syndrome ； Total parenteral nutrition