CAJ | 학술논문

目的观察肠内营养能否降低外科手术患者血液内毒素水平。方法41位接受外科大手术患者随机分成肠内营养组和肠外营养组，其中肠内营养组21例，肠外营养组20例。在术后第1日开始行肠内营养或肠外营养支持。术前、术后第3日和第8日抽血查白蛋白、纤维连接蛋白、转铁蛋白、r-GT、SGPT、胆红素以及内毒素。结果两组患者均未出现吻合口漏、腹腔感染等严重并发症。术前两组各项指标均无显著性差异(P>0.05)。术后第3日和术后第8日，两组蛋白指标无显著性差异(P>0.05)。术后，肠外营养组r-GT水平持续升高，而肠内营养则抑制了r-GT的升高，术后第8日两组r-GT水平有非常显著性差异(P<0.01)。两组的SGPT和胆红素在手术前后无显著性变化(P>0.05)。术后第3日，EN组内毒素值有轻度升高，到术后第8日内毒素值开始下降。而PN组在术后第3日，内毒素值也开始升高，升高的幅度较EN组要大(P<0.01)，术后第8日EN组内毒素有轻度下降，PN组内毒素则继续升高，其两者相比有非常显著性差异(P<0.01)。结论和肠外营养相比，肠内营养能降低外科手术患者血液内毒素水平。
목적관찰장내영양능부강저외과수술환자혈액내독소수평。방법41위접수외과대수술환자수궤분성장내영양조화장외영양조，기중장내영양조21례，장외영양조20례。재술후제1일개시행장내영양혹장외영양지지。술전、술후제3일화제8일추혈사백단백、섬유련접단백、전철단백、r-GT、SGPT、담홍소이급내독소。결과량조환자균미출현문합구루、복강감염등엄중병발증。술전량조각항지표균무현저성차이(P>0.05)。술후제3일화술후제8일，량조단백지표무현저성차이(P>0.05)。술후，장외영양조r-GT수평지속승고，이장내영양칙억제료r-GT적승고，술후제8일량조r-GT수평유비상현저성차이(P<0.01)。량조적SGPT화담홍소재수술전후무현저성변화(P>0.05)。술후제3일，EN조내독소치유경도승고，도술후제8일내독소치개시하강。이PN조재술후제3일，내독소치야개시승고，승고적폭도교EN조요대(P<0.01)，술후제8일EN조내독소유경도하강，PN조내독소칙계속승고，기량자상비유비상현저성차이(P<0.01)。결론화장외영양상비，장내영양능강저외과수술환자혈액내독소수평。
Objective To investigate whether enteral nutrition decreases thelevel of blood endotoxin in patients undergoing surgery,compared with the parenteral nutrition. Methods Forty-one patients undegoing major abdominal surgery were randomized into enteral nutrition group (n=21) and parenteral nutrition group (n=20).On the day 1 postoperatively,the patients received tither enteral nutrition or parenteral nutrition.Blood samples were obtained for determining the level of albumin,transferin,fibronectin,γ-GT,ALT,bilirubin and endotoxin were measured on day 0,day3 and day8 of postoperatively. Results No serious side-effects and complications such as anastomosis fistula and abdominal infection were observed in both groups.There were no significant differences between two groups preoperation.The level of proteins in both groups has no significant difference on day 3,day 8 postoperatively.The patients receiving parenteral nutrition had an increasing in γ-GT after the operation.There was a significant difference in the level of γ-GT between two groups on the day 8 postoperatively.ALT and bilirubin had no significant changes during the period.The level of endotoxin in enteral nutrition group increased on day 3 postoperatively,and decreased on day 8 postoperatively.The level of endotoxin in parenteral nutrition group began to increase on day 3 postoperatively,and continued to increase on day 8 postoperatively.There was a significant difference between two groups in the level of endotoxin on day 3 postoperatively and on day 8 postoperatively(P<0.01). Conclusions Compared with the parenteal nutrition,enteral nutrition can decrease the level of blood endotoxin in patients undergoing surgery.