CAJ | 학술논문

目的观察肠内营养(EN)对合并肝功能障碍患者腹部手术后肝功能及炎性反应的影响.方法 2009年8月至2010年3月前瞻性选择南京、上海等地区5家医院的62例腹部手术后需要EN支持5 d以上且至少存在一项肝功能指标异常的患者,术后胃肠功能恢复后给予EN混悬液(TPF-FOS)5 d,EN达到目标量125.52 kJ(30 kcal)·kg-1·d-1至少3 d.于术前、EN开始后第6天晨分别检测血清前白蛋白、C反应蛋白(CRP)及肝功能指标水平并记录全身炎性反应综合征发生率,于EN使用期间观察并记录胃肠道反应发生率.结果术前与EN后的血清前白蛋白水平分别为(175.94±71.79)mg/L和(192.22±91.26)mg/L,差异无统计学意义(P=0.162).术前γ-谷氨酰转肽酶异常者为40例,EN后减少至30例(P=0.041);术前总胆红素异常者为9例,EN后减少至3例(P=0.034);其余肝功能指标异常者的例数术前与EN后无差异.总胆红素与结合型胆红素水平EN后较术前显著降低(分别为P=0.000和P=0.015).与术前CRP值(48.74±65.16)m/L相比,EN后降至(25.79±23.63)mg/L(P=0.009);与术前全身炎性反应综合征发生率19.0%相比,EN后降至10.3%(P=0.059).患者胃肠道反应的发生率EN第1天为22.4%,EN第5天则减少为19.0%,随管饲喂养时间的延长呈下降趋势.结论对于合并肝功能障碍的腹部中等以上手术患者,术后应用TPF-FOS能减轻机体的炎性反应,改善肝功能,维持血清蛋白水平.
목적 관찰장내영양(EN)대합병간공능장애환자복부수술후간공능급염성반응적영향.방법 2009년8월지2010년3월전첨성선택남경、상해등지구5가의원적62례복부수술후수요EN지지5 d이상차지소존재일항간공능지표이상적환자,술후위장공능회복후급여EN혼현액(TPF-FOS)5 d,EN체도목표량125.52 kJ(30 kcal)·kg-1·d-1지소3 d.우술전、EN개시후제6천신분별검측혈청전백단백、C반응단백(CRP)급간공능지표수평병기록전신염성반응종합정발생솔,우EN사용기간관찰병기록위장도반응발생솔.결과 술전여EN후적혈청전백단백수평분별위(175.94±71.79)mg/L화(192.22±91.26)mg/L,차이무통계학의의(P=0.162).술전γ-곡안선전태매이상자위40례,EN후감소지30례(P=0.041);술전총담홍소이상자위9례,EN후감소지3례(P=0.034);기여간공능지표이상자적례수술전여EN후무차이.총담홍소여결합형담홍소수평EN후교술전현저강저(분별위P=0.000화P=0.015).여술전CRP치(48.74±65.16)m/L상비,EN후강지(25.79±23.63)mg/L(P=0.009);여술전전신염성반응종합정발생솔19.0%상비,EN후강지10.3%(P=0.059).환자위장도반응적발생솔EN제1천위22.4%,EN제5천칙감소위19.0%,수관사위양시간적연장정하강추세.결론 대우합병간공능장애적복부중등이상수술환자,술후응용TPF-FOS능감경궤체적염성반응,개선간공능,유지혈청단백수평.
Objective To investigate the effect of enteral nutrition (EN) on liver function and inflammatory response after abdominal operation in patients with liver dysfunction. Methods A prospective multicenter study was conducted. Patients requiring EN for at least 5 days after abdominal surgery with at least 1 abnormal liver function index were included. After operations, EN suspensions (TPF-FOS) were administered for 5 days after the return of bowel function with targeted content of 125.52 kJ (30 kcal)·g-1·d-1 maintained for a minimum of 3 days. Levels of serum pre-albumin, C-reaction protein (CRP), and liver function index were measured and the incidence of systemic inflammatory response syndrome (SIRS) was recorded before operation and 6 days after EN. Occurence of gastrointestinal discomfort was monitored during the treatment. Results No statistically significant difference was found in pre-albumin between preoperative level and post-EN level [(175.94±71.79) mg/L vs. (192.22±91.26) mg/L,P=0.162]. Patients with abnormal level of γ-glutamyl transpeptidase were less after EN compared to the preoperative period (30 vs. 40, P=0.041), as was total bilirubin (3vs.9, P=0.034). No significant differences in other indices of liver function were found. Total bilirubin and direct bilirubin decreased after EN support (P=0.000 and P=0.015, respectively). CRP was notably reduced after EN support [(48.74±65.16) mg/L vs. (25.79±23.63) mg/L, P=0.009] and the incidence of SIRS largely declined after EN support(19.0% vs. 10.3%,P=0.059). The incidence of gastrointestinal discomfort was 22.4% on postoperative day 1 and declined to 19.0% on postoperative day 5. Conclusion For patients with liver dysfunction, enteral nutrition support with TPF-FOS after abdominal operation can reduce inflammatory response, improve liver function, and maintain serum protein level.