CAJ | 학술논문

目的：评价肠内营养对老年患者腹部手术后营养代谢和肠黏膜通透性的影响。方法将68例老年腹部手术患者按随机数字表法分为肠内营养组（肠内组）35例和肠外营养组（肠外组）33例，分别给予整蛋白型肠内营养和等氮、等热卡的肠外营养，观察并比较两组患者血浆谷氨酰胺、蛋白和累积氮平衡水平、肠黏膜通透性、血浆免疫球蛋白lgG和IgM水平以及感染有关并发症、营养治疗费用等的差异。结果不同营养支持6d后，肠内组血浆谷氨酰胺（422±54）μmol/L、累积6d氮平衡（30.3±24.0） mg/kg，lgG和lgM分别为（12.4±1.9）g/L和（1450±760）mg/L，均高于肠外组（均P＜0.05）；用药前后甘露醇/乳果糖比值的差值为0.036±0.019，高于肠外组的0.013±0.011（P＜0.01）；肠内组发生感染并发症3例，肠外组5例；肠内组的营养治疗费用低于肠外组（P＜0.01）。结论肠内营养能进一步改善患者营养代谢，维护其肠黏膜屏障，减少感染并发症的发生，且更为经济。
목적：평개장내영양대노년환자복부수술후영양대사화장점막통투성적영향。방법장68례노년복부수술환자안수궤수자표법분위장내영양조（장내조）35례화장외영양조（장외조）33례，분별급여정단백형장내영양화등담、등열잡적장외영양，관찰병비교량조환자혈장곡안선알、단백화루적담평형수평、장점막통투성、혈장면역구단백lgG화IgM수평이급감염유관병발증、영양치료비용등적차이。결과불동영양지지6d후，장내조혈장곡안선알（422±54）μmol/L、루적6d담평형（30.3±24.0） mg/kg，lgG화lgM분별위（12.4±1.9）g/L화（1450±760）mg/L，균고우장외조（균P＜0.05）；용약전후감로순/유과당비치적차치위0.036±0.019，고우장외조적0.013±0.011（P＜0.01）；장내조발생감염병발증3례，장외조5례；장내조적영양치료비용저우장외조（P＜0.01）。결론장내영양능진일보개선환자영양대사，유호기장점막병장，감소감염병발증적발생，차경위경제。
Objective To evaluate the nutritional metabolism and intestinal permeability in elderly patients with postoper-ative enteral nutrition(EN) or parenteral nutrition(PN). Methods Sixty eight elderly patients undergoing abdominal operation were randomly divided into EN group(n=35) and PN group (n=33). EN group received protein nutrition (Fresubin neutral), PN group re-ceived protein nutrition of equal nitrogen and equal calories with the EN group. The plasma glutamine concentration, plasma pro-tein and accumulated nitrogen balance, intestinal permeability, immune globulin (IgG, IgM) and infection- related complications, nutritional treatment costs were documented and compared. Results After 6d of nutritional support, the plasma glutamine con-centration (422±54μmol/L ), accumulated nitrogen balance(30.3±24.0 mg/kg), IgG (12.4±1.9g/L) and IgM (1450±760Mg/L) in EN group were higher than those in PN group (P<0.05). Change of L/M ratio in EN group was higher than that in PN group (0.036±0.0191,0.013±0.011, P<0.01). One patient in EN group and two patients in PN group presented infection- related com-plications. The cost of nutritional support in EN group was lower than that in PN group(P<0.01). Conclusion Enteral nutrition can improve nutritional metabolisim, support intestinal permeability barrier, decrease the complications and more economical in el-derly patients after abdominal operation.