CAJ | 학술논문

目的通过比较不同营养支持方案的作用,评价ω-3多不饱和脂肪酸联合营养支持治疗在肝切除术后应用的临床效果.方法采用回顾性对照研究的方法.选择2009年1月-2011年1月南京大学医学院附属鼓楼医院82例行肝切除术患者,依照围手术期不同的营养支持方案分为全肠外营养组(23例,简称肠外组)、联合肠内营养组(30例,简称肠内组)和ω-3不饱和脂肪酸组(29例,简称ω-3 PUFAs组).肠外组术后给予全肠外营养支持;肠内组在静脉营养支持基础上术后早期口服肠内营养;ω-3 PUFAs组在肠内组基础上,术后加用ω-3多不饱和脂肪酸.通过比较3组患者术后恢复情况、并发症发病率、肝功能等临床指标综合评估不同营养支持方案的疗效.结果 (1)3组患者术后均无胆漏、胆道出血等严重并发症,轻微并发症包括腹腔积液、胸腔积液,3组间差异无统计学意义;(2)与肠外组比较,肠内组、ω-3 PUFAs组术后排便时间、术后住院天数较短,差异有统计学意义(P =0.001,=4.624;P =0.001,t =5.019);肠内组、ω-3PUFAs组间差异无统计学意义(P＞0.05);(3)对于大范围(≥4个肝段)肝切除患者,与肠内组相比,ω-3PUFAs组术后第3、5天ALT值较低,差异有统计学意义(P=0.024,t=2.432;P=0.042,=2.144);(4)对于有肝硬化的患者,与肠内组相比,ω-3 PUFAs组术后第3、5天胆红素值较低,差异有统计学意义(P=0.032,t=2.202;P=0.035,t =2.183).结论肝切除术后早期给予肠内营养并联合肠外营养支持,可加速患者康复;对于有肝硬化背景及大范围肝切除的患者,ω-3 PUFAs联合营养支持治疗对肝功能的保护作用尤为明显.
목적 통과비교불동영양지지방안적작용,평개ω-3다불포화지방산연합영양지지치료재간절제술후응용적림상효과.방법 채용회고성대조연구적방법.선택2009년1월-2011년1월남경대학의학원부속고루의원82례행간절제술환자,의조위수술기불동적영양지지방안분위전장외영양조(23례,간칭장외조)、연합장내영양조(30례,간칭장내조)화ω-3불포화지방산조(29례,간칭ω-3 PUFAs조).장외조술후급여전장외영양지지;장내조재정맥영양지지기출상술후조기구복장내영양;ω-3 PUFAs조재장내조기출상,술후가용ω-3다불포화지방산.통과비교3조환자술후회복정황、병발증발병솔、간공능등림상지표종합평고불동영양지지방안적료효.결과 (1)3조환자술후균무담루、담도출혈등엄중병발증,경미병발증포괄복강적액、흉강적액,3조간차이무통계학의의;(2)여장외조비교,장내조、ω-3 PUFAs조술후배편시간、술후주원천수교단,차이유통계학의의(P =0.001,=4.624;P =0.001,t =5.019);장내조、ω-3PUFAs조간차이무통계학의의(P＞0.05);(3)대우대범위(≥4개간단)간절제환자,여장내조상비,ω-3PUFAs조술후제3、5천ALT치교저,차이유통계학의의(P=0.024,t=2.432;P=0.042,=2.144);(4)대우유간경화적환자,여장내조상비,ω-3 PUFAs조술후제3、5천담홍소치교저,차이유통계학의의(P=0.032,t=2.202;P=0.035,t =2.183).결론 간절제술후조기급여장내영양병연합장외영양지지,가가속환자강복;대우유간경화배경급대범위간절제적환자,ω-3 PUFAs연합영양지지치료대간공능적보호작용우위명현.
Objective By comparing the therapeutic effects of different nutrition support,to elementarily evaluate the protocol of nutrition support with ω-3 polyunsaturated fatty acids in patients undergoing hepatectomy.Methods Retrospective and comparative analysis was applied.From January 2009 to January 2011,82 patients undergoing liver resection were selected from Nanjing Drum Tower Hospital and divided into three groups according to different nutrition supporting protocol:total parenteral nutrition group (23,TPN for short),combined enteral nutrition group (30,EN for short),ω-3 PUFAs group (29).TPN group was given total parenteral nutrition.EN group was given both parenteral and enteral nutrition.ω-3 PUFAs group was given parenteral nutrition,enteral nutrition and ω-3 PUFAs.By comparing the general situation,the incidence of post-operation complications and index of liver function,the effect of different nutrition supporting plans could be comprehensively evaluated.Results (1) None patients from any groups had severe complications such as bile leakage and hemobilia.Slight complications included ascites and pleural effusion.No difference is of significance in statistics science.(2) Compared with TPN group,patients from EN and ω-3 PUFAs group had shorter defecating time and post-surgery hospital stay,the difference is of significance in statistics science (P =0.001,t =4.624; P =0.001,t =5.019).There was no significant difference between EN and ω-3 PUFAs group (P ＞ 0.05).(3) For patients received operation with major hepatectomy (≥4 segments),ALT in ω-3 PUFAs group was lower than EN group in the 3rd and 5th day after operation (P=0.024,t =2.432; P=0.042,t =2.144).(4) For patients with cirrhosis,TB in ω-3 PUFAs group was lower than EN group in the 3rd and 5th day after operation (P =0.032,t =2.202; P =0.035,t =2.183).Conclusions It is beneficial to use nutritional support in patients received hepatectomy.For patients received major hepatectomy and patients with cirrhosis,nutrition support with ω-3 PUFAs had better protective effects.