中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2011年
3期
148-153
,共6页
康维明%于健春%马志强%王瑾%葛军娜%李志田
康維明%于健春%馬誌彊%王瑾%葛軍娜%李誌田
강유명%우건춘%마지강%왕근%갈군나%리지전
胃肠道手术%营养支持%早期肠内营养%肠外营养
胃腸道手術%營養支持%早期腸內營養%腸外營養
위장도수술%영양지지%조기장내영양%장외영양
Gastrointestinal surgery%Nutritional support%Early enteral nutrition%Parenteral nutrition
目的 比较胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床疗效.方法 采用随机数字表法,将126例拟行开腹胃肠道手术的患者随机分为早期肠内肠外营养支持疗法组(EEN+PN组,n=62)和肠外营养支持组(PN组,n=64),分别于手术前,手术后第3、7天监测患者的体重、体重指数、血清白蛋白、前白蛋白、血脂、血生化、血淋巴细胞计数、血C反应蛋白变化情况,比较两组患者术后胃肠道功能恢复时间、手术并发症、营养支持相关费用及住院天数.结果 术前两组患者的营养相关指标、血生化指标和炎症及免疫指标差异均无统计学意义(P>0.05);术后第3天,EEN+PN组患者前白蛋白水平显著高于PN组[(160.3±23.0)g/L比(137.0±28.7)g/L,P=0.000];术后第7天,EEN+PN组患者前白蛋白[(210.6±34.6)g/L比(154.8±36.9)g/L,P=0.000]、白蛋白[(33.6±3.8)g/L比(31.8±4.7)g/L,P=0.042]、淋巴细胞计数[(2.33±0.53)×109/L比(1.04±0.36)×109/L,P=0.046]水平均显著高于PN组,血γ-谷氨酰转肽酶[(48.12±33.84)U/L比(71.54±34.00)U/L,P=0.048]、C反应蛋白[(31.15±19.00)mmol/L比(45.90±23.21)mmol/L,P=0.042]、总胆固醇[(3.09±0.83)mmol/L比(3.29±0.91)mmoL/L,P=0.045]、低密度脂蛋白[(2.01±0.39)mmoi/L比(2.31±0.72)mmol/L,P=0.049]水平显著低于PN组.EEN+PN组患者术后胃肠道功能恢复时间显著短于PN组[(65.7±15.6)h比(75.1±27.0)h,P=0.036],围手术营养支持疗法总费用显著低于PN组[(2634.5±1306.8)元比(3058.6±1216.0)元,P=0.046].结论 胃肠道手术后早期规范化序贯肠内肠外营养支持疗法可以改善机体术后前白蛋白水平,有益于术后患者免疫功能和组织损伤水平的恢复,促进早期胃肠道功能恢复,降低营养支持疗法相关费用.
目的 比較胃腸道手術後規範化序貫腸內腸外營養支持療法與腸外營養支持的臨床療效.方法 採用隨機數字錶法,將126例擬行開腹胃腸道手術的患者隨機分為早期腸內腸外營養支持療法組(EEN+PN組,n=62)和腸外營養支持組(PN組,n=64),分彆于手術前,手術後第3、7天鑑測患者的體重、體重指數、血清白蛋白、前白蛋白、血脂、血生化、血淋巴細胞計數、血C反應蛋白變化情況,比較兩組患者術後胃腸道功能恢複時間、手術併髮癥、營養支持相關費用及住院天數.結果 術前兩組患者的營養相關指標、血生化指標和炎癥及免疫指標差異均無統計學意義(P>0.05);術後第3天,EEN+PN組患者前白蛋白水平顯著高于PN組[(160.3±23.0)g/L比(137.0±28.7)g/L,P=0.000];術後第7天,EEN+PN組患者前白蛋白[(210.6±34.6)g/L比(154.8±36.9)g/L,P=0.000]、白蛋白[(33.6±3.8)g/L比(31.8±4.7)g/L,P=0.042]、淋巴細胞計數[(2.33±0.53)×109/L比(1.04±0.36)×109/L,P=0.046]水平均顯著高于PN組,血γ-穀氨酰轉肽酶[(48.12±33.84)U/L比(71.54±34.00)U/L,P=0.048]、C反應蛋白[(31.15±19.00)mmol/L比(45.90±23.21)mmol/L,P=0.042]、總膽固醇[(3.09±0.83)mmol/L比(3.29±0.91)mmoL/L,P=0.045]、低密度脂蛋白[(2.01±0.39)mmoi/L比(2.31±0.72)mmol/L,P=0.049]水平顯著低于PN組.EEN+PN組患者術後胃腸道功能恢複時間顯著短于PN組[(65.7±15.6)h比(75.1±27.0)h,P=0.036],圍手術營養支持療法總費用顯著低于PN組[(2634.5±1306.8)元比(3058.6±1216.0)元,P=0.046].結論 胃腸道手術後早期規範化序貫腸內腸外營養支持療法可以改善機體術後前白蛋白水平,有益于術後患者免疫功能和組織損傷水平的恢複,促進早期胃腸道功能恢複,降低營養支持療法相關費用.
목적 비교위장도수술후규범화서관장내장외영양지지요법여장외영양지지적림상료효.방법 채용수궤수자표법,장126례의행개복위장도수술적환자수궤분위조기장내장외영양지지요법조(EEN+PN조,n=62)화장외영양지지조(PN조,n=64),분별우수술전,수술후제3、7천감측환자적체중、체중지수、혈청백단백、전백단백、혈지、혈생화、혈림파세포계수、혈C반응단백변화정황,비교량조환자술후위장도공능회복시간、수술병발증、영양지지상관비용급주원천수.결과 술전량조환자적영양상관지표、혈생화지표화염증급면역지표차이균무통계학의의(P>0.05);술후제3천,EEN+PN조환자전백단백수평현저고우PN조[(160.3±23.0)g/L비(137.0±28.7)g/L,P=0.000];술후제7천,EEN+PN조환자전백단백[(210.6±34.6)g/L비(154.8±36.9)g/L,P=0.000]、백단백[(33.6±3.8)g/L비(31.8±4.7)g/L,P=0.042]、림파세포계수[(2.33±0.53)×109/L비(1.04±0.36)×109/L,P=0.046]수평균현저고우PN조,혈γ-곡안선전태매[(48.12±33.84)U/L비(71.54±34.00)U/L,P=0.048]、C반응단백[(31.15±19.00)mmol/L비(45.90±23.21)mmol/L,P=0.042]、총담고순[(3.09±0.83)mmol/L비(3.29±0.91)mmoL/L,P=0.045]、저밀도지단백[(2.01±0.39)mmoi/L비(2.31±0.72)mmol/L,P=0.049]수평현저저우PN조.EEN+PN조환자술후위장도공능회복시간현저단우PN조[(65.7±15.6)h비(75.1±27.0)h,P=0.036],위수술영양지지요법총비용현저저우PN조[(2634.5±1306.8)원비(3058.6±1216.0)원,P=0.046].결론 위장도수술후조기규범화서관장내장외영양지지요법가이개선궤체술후전백단백수평,유익우술후환자면역공능화조직손상수평적회복,촉진조기위장도공능회복,강저영양지지요법상관비용.
Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.
