减重手术患者短期内胃肠道症状变化影响因素的纵向研究及护理启示

doi:10.3761/j.issn.0254-1769.2025.14.013

摘要/Abstract

摘要： 目的探讨腹腔镜胃袖状切除术（laparoscopic sleeve gastrectomy，LSG）前后患者胃肠道症状和食物耐受性的变化及影响因素，为制订针对性的胃肠道症状管理方案提供参考。方法采用方便抽样法，选取2023年6月— 11月在徐州市某三级甲等医院减重代谢外科行LSG的125例患者进行前瞻性观察性研究，采用一般资料调查表、食物耐受性问卷和胃肠道症状评定量表（Gastrointestinal Symptom Rating Scale，GSRS）于术前、术后3个月、术后6个月进行调查，采用双因素重复测量方差分析、广义线性混合模型分析胃肠道症状的影响因素。结果回收有效问卷116份，LSG患者3个时间点GSRS得分分别为（21.67±5.80）（23.28±4.33）（21.22±3.18）分；食物不耐受的发生率分别为0、32.75%、28.45%。患者术后的肠鸣音、吞咽困难、便秘、大便干结症状较术前加重（均P<0.05），是否有口气、腹泻、大便稀、有便意需立即排便症状较术前缓解（均P<0.05）。结果显示，进餐时间短、常见食物耐受性差、高中/中专文化程度、呕吐/反流频率高是增加胃肠道症状的危险因素（均P<0.05）。结论 LSG后会增加吞咽困难、消化不良、便秘等胃肠道症状和食物不耐受的患病率。医护人员应重视LSG患者的胃肠道症状评估，尤其是高中/中专学历、进餐时间短、常见食物耐受性差、呕吐/反流频率高的患者，加强术后随访，构建具有针对性的治疗护理方案，预防并减少此类不适症状。

关键词: 腹腔镜胃袖状切除术, 胃肠道症状, 食物耐受性, 影响因素分析, 护理

Abstract:

Objective To explore the changes and influencing factors in patients’ gastrointestinal symptoms and food tolerance before and after laparoscopic sleeve gastrectomy（LSG），and to provide a reference for the development of targeted gastrointestinal symptoms management program. Methods A convenience sampling method was used to select 125 patients who underwent LSG in the bariatric and metabolic surgery department of a tertiary-level hospital in Xuzhou City from June to November 2023 for a prospective observational study. The general information questionnaire，food tolerance questionnaire and Gastrointestinal Symptom Rating Scale （GSRS） were used to investigate at preoperative，3 months after surgery，and 6 months after surgery. Two-factor repeated measures variance analysis and generalized linear mixed model（GLMM） was used to analyze the influencing factors of gastrointestinal symptoms. Results 116 valid questionnaires were collected，and the GSRS scores of LSG patients at 3 time points were 21.67±5.80，23.28±4.33，and 21.22±3.18 respectively；the incidence rates of food intolerance were 0，32.75%，and 28.45% respectively. The patients’ symptoms of bowel sounds，dysphagia，constipation，and dry stool were worse after surgery than before surgery（all P<0.05），and the symptoms of bad breath，diarrhea，loose stools，and the need to defecate immediately were alleviated compared with symptoms before surgery（all P<0.05）. GLMM results showed that short meal times，poor food tolerance，and high school/technical secondary school education were risk factors for increasing gastrointestinal symptoms（all P<0.05）. Conclusion LSG could increase the prevalence of gastrointestinal symptoms such as dysphagia，dyspepsia，constipation and food intolerance. Medical staff should pay attention to the assessment of gastrointestinal symptoms in LSG patients，especially for patients with short meal time and poor food tolerance，strengthen postoperative follow-up，build targeted treatment and care plan，and prevent and reduce such uncomfortable symptoms.

Key words: Laparoscopic Sleeve Gastrectomy, Gastrointestinal Symptoms, Food Tolerance, Root Cause Analysis, Nursing Care

赵会玲, 吴路路, 张小曼, 孙霞, 张丹, 刘玉平. 减重手术患者短期内胃肠道症状变化影响因素的纵向研究及护理启示[J]. 中华护理杂志, 2025, 60(14): 1742-1748.

ZHAO Huiling, WU Lulu, ZHANG Xiaoman, SUN Xia, ZHANG Dan, LIU Yuping. A longitudinal study on short-term changes in gastrointestinal symptoms and influencing factors in patients undergoing bariatric surgery[J]. Chinese Journal of Nursing, 2025, 60(14): 1742-1748.

图/表 5

表1 腹腔镜胃切除患者一般资料及不同时间点胃肠道症状的比较（n=116）

Table 1 General information questionnaire of patients undergoing laparoscopic gastrectomy and comparison of scores of gastrointestinal symptoms at different time points（n=116）

表2 腹腔镜胃袖状切除前后患者胃肠道症状的比较[分，M（P25，P75），n=116）]

Table 2 Comparison of gastrointestinal symptoms in patients before and after laparoscopic sleeve gastrectomy[scores，M（P25，P75），n=116）]

表3 腹腔镜胃切除术前后患者食物耐受性比较（n=116 $\bar{x} \pm s$）

Table 3 Changes in food tolerance of patients before and after laparoscopic gastrectomy（n=116，$\bar{x} \pm s$）

表4 在腹腔镜胃袖状切除术患者最常见的不耐受食物类型比[n=116，例（百分率，%）]

Table 4 The most common types of food intolerance in patients after laparoscopic sleeve gastrectomy[n=116，case（percentage，%）]

表5 腹腔镜胃袖状切除患者发生胃肠道症状的广义线性混合模型分析结果（n=116）

Table 5 GLMM analysis results of gastrointestinal symptoms in patients after laparoscopic sleeve gastrectomy（n=116）

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