目的 观察经鼻空肠管行肠内营养后患者肝功能的变化.方法 选取2011年9月至2014年8月郑州人民医院重症医学科需经鼻饲管行肠内营养的住院患者74例,采用随机数字表法分为鼻空肠管组(n=36)与鼻胃管组(n=38),分别留置鼻空肠管与鼻胃管,启动早期肠内营养.观察两组患者开始肠内营养后第7、14天的肝功能各项指标.结果 鼻空肠管组31例患者(86.11％)出现至少1项肝功能异常,鼻胃管组23例(60.53％)出现至少1项肝功能异常,差异有统计学意义(x2=6.136,P=0.013).鼻胃管组与鼻空肠管组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GGT)及白蛋白(ALB)在第7天的差异无统计学意义[(39.1±8.6)U/L比(42.3±8.9) U/L,t=-1.475,P=0.145;(36.2±6.8) U/L比(38.0±7.1) U/L,t=-1.237,P=0.220;(61.8±11.5) U/L比(63.1±13.2) U/L,t=-0.696,P=0.489;(47.3 ±8.2) U/L比(50.5±7.5) U/L,t=-1.640,P=0.106;(35.2±6.7) g/L比(36.2±7.4)g/L,t-0.610,P=0.543];第14天鼻空肠管组ALP、γ-GGT及ALB水平显著高于鼻胃管组[(201.2±15.2)U/L比(116.5±13.6) U/L,t=-25.380,P=0.000;(109.4±7.2) U/L比(49.2±6.5) U/L,t=-37.665,P=0.000;(37.2±7.1) g/L比(30.1±6.5) g/L,t=-4.490,P=0.000].鼻胃管组与鼻空肠管组第7、14天的总胆红素[(4.6±0.9)μmol/L比(4.8±1.0) μmol/L,t=-0.905,P=0.368;(4.8±1.2)μmol/L比(5.2±1.1)μmol/L,t=-1.492,P=0.140]、间接胆红素[(6.1±0.8)μmol/L比(6.3±0.9) μmol/L,t=-1.012,P=0.315;(6.9±0.9)μmol/L比(7.3±1.0)μmol/L,t=-1.811,P=0.074]、直接胆红素[(4.0±0.6) μmol/L比(3.9±0.5)μmol/L,t=0.777,P=0.440;(5.1±0.8)μmol/L比(5.4±0.9) μmol/L,t=-1.517,P=0.134]差异均无统计学意义.鼻空肠管组肺部感染发生率显著低于鼻胃管组(30.56％比55.26％,x2 =4.598,P=0.032).结论 与经鼻胃管行肠内营养比较,经鼻空肠管行肠内营养可能更易导致肝功能异常.
目的 觀察經鼻空腸管行腸內營養後患者肝功能的變化.方法 選取2011年9月至2014年8月鄭州人民醫院重癥醫學科需經鼻飼管行腸內營養的住院患者74例,採用隨機數字錶法分為鼻空腸管組(n=36)與鼻胃管組(n=38),分彆留置鼻空腸管與鼻胃管,啟動早期腸內營養.觀察兩組患者開始腸內營養後第7、14天的肝功能各項指標.結果 鼻空腸管組31例患者(86.11％)齣現至少1項肝功能異常,鼻胃管組23例(60.53％)齣現至少1項肝功能異常,差異有統計學意義(x2=6.136,P=0.013).鼻胃管組與鼻空腸管組患者穀丙轉氨酶(ALT)、穀草轉氨酶(AST)、堿性燐痠酶(ALP)、γ-穀氨酰轉肽酶(γ-GGT)及白蛋白(ALB)在第7天的差異無統計學意義[(39.1±8.6)U/L比(42.3±8.9) U/L,t=-1.475,P=0.145;(36.2±6.8) U/L比(38.0±7.1) U/L,t=-1.237,P=0.220;(61.8±11.5) U/L比(63.1±13.2) U/L,t=-0.696,P=0.489;(47.3 ±8.2) U/L比(50.5±7.5) U/L,t=-1.640,P=0.106;(35.2±6.7) g/L比(36.2±7.4)g/L,t-0.610,P=0.543];第14天鼻空腸管組ALP、γ-GGT及ALB水平顯著高于鼻胃管組[(201.2±15.2)U/L比(116.5±13.6) U/L,t=-25.380,P=0.000;(109.4±7.2) U/L比(49.2±6.5) U/L,t=-37.665,P=0.000;(37.2±7.1) g/L比(30.1±6.5) g/L,t=-4.490,P=0.000].鼻胃管組與鼻空腸管組第7、14天的總膽紅素[(4.6±0.9)μmol/L比(4.8±1.0) μmol/L,t=-0.905,P=0.368;(4.8±1.2)μmol/L比(5.2±1.1)μmol/L,t=-1.492,P=0.140]、間接膽紅素[(6.1±0.8)μmol/L比(6.3±0.9) μmol/L,t=-1.012,P=0.315;(6.9±0.9)μmol/L比(7.3±1.0)μmol/L,t=-1.811,P=0.074]、直接膽紅素[(4.0±0.6) μmol/L比(3.9±0.5)μmol/L,t=0.777,P=0.440;(5.1±0.8)μmol/L比(5.4±0.9) μmol/L,t=-1.517,P=0.134]差異均無統計學意義.鼻空腸管組肺部感染髮生率顯著低于鼻胃管組(30.56％比55.26％,x2 =4.598,P=0.032).結論 與經鼻胃管行腸內營養比較,經鼻空腸管行腸內營養可能更易導緻肝功能異常.
목적 관찰경비공장관행장내영양후환자간공능적변화.방법 선취2011년9월지2014년8월정주인민의원중증의학과수경비사관행장내영양적주원환자74례,채용수궤수자표법분위비공장관조(n=36)여비위관조(n=38),분별류치비공장관여비위관,계동조기장내영양.관찰량조환자개시장내영양후제7、14천적간공능각항지표.결과 비공장관조31례환자(86.11％)출현지소1항간공능이상,비위관조23례(60.53％)출현지소1항간공능이상,차이유통계학의의(x2=6.136,P=0.013).비위관조여비공장관조환자곡병전안매(ALT)、곡초전안매(AST)、감성린산매(ALP)、γ-곡안선전태매(γ-GGT)급백단백(ALB)재제7천적차이무통계학의의[(39.1±8.6)U/L비(42.3±8.9) U/L,t=-1.475,P=0.145;(36.2±6.8) U/L비(38.0±7.1) U/L,t=-1.237,P=0.220;(61.8±11.5) U/L비(63.1±13.2) U/L,t=-0.696,P=0.489;(47.3 ±8.2) U/L비(50.5±7.5) U/L,t=-1.640,P=0.106;(35.2±6.7) g/L비(36.2±7.4)g/L,t-0.610,P=0.543];제14천비공장관조ALP、γ-GGT급ALB수평현저고우비위관조[(201.2±15.2)U/L비(116.5±13.6) U/L,t=-25.380,P=0.000;(109.4±7.2) U/L비(49.2±6.5) U/L,t=-37.665,P=0.000;(37.2±7.1) g/L비(30.1±6.5) g/L,t=-4.490,P=0.000].비위관조여비공장관조제7、14천적총담홍소[(4.6±0.9)μmol/L비(4.8±1.0) μmol/L,t=-0.905,P=0.368;(4.8±1.2)μmol/L비(5.2±1.1)μmol/L,t=-1.492,P=0.140]、간접담홍소[(6.1±0.8)μmol/L비(6.3±0.9) μmol/L,t=-1.012,P=0.315;(6.9±0.9)μmol/L비(7.3±1.0)μmol/L,t=-1.811,P=0.074]、직접담홍소[(4.0±0.6) μmol/L비(3.9±0.5)μmol/L,t=0.777,P=0.440;(5.1±0.8)μmol/L비(5.4±0.9) μmol/L,t=-1.517,P=0.134]차이균무통계학의의.비공장관조폐부감염발생솔현저저우비위관조(30.56％비55.26％,x2 =4.598,P=0.032).결론 여경비위관행장내영양비교,경비공장관행장내영양가능경역도치간공능이상.
Objective To observe the liver function changes in patients after enteral nutrition through nasal jejunal tube.Methods Altogether 74 inpatients requiring enteral nutrition were collected for this study from September 2011 to August 2014 in the Intensive Care Unit of Zhengzhou People's Hospital and divided into 2 groups with random number table:the nasal jejunal tube group (n =36) and the nasogastric tube group (n ＝38),with nasal jejunal tube and nasogastric tube inserted,respectively,for early enteral nutrition.We observed the two groups of patients in terms of liver function indexes on day 7 and day 14 after starting enteral nutrition.Results In the nasal jejunal tube group,31 patients (86.11％) showed abnormality in at least 1 liver function index,while that number was 23 in the nasogastric tube group (60.53％),with significant inter-group difference (x2 =6.136,P =0.013).On day 7 after enteral nutrition,there were no significant differences in alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptidase (γ-GGT) and albumin (ALB) between the two groups [(39.1 ± 8.6) U/L vs.(42.3 ±8.9) U/L,t=-1.475,P=0.145;(36.2±6.8) U/Lvs.(38.0±7.1) U/L,t=-1.237,P=0.220;(61.8±11.5) U/Lvs.(63.1 ±13.2) U/L,t=-0.696,P=0.489;(47.3±8.2) U/Lvs.(50.5±7.5) U/L,t=-1.640,P=0.106;(35.2±6.7) g/Lvs.(36.2±7.4) g/L,t=-0.610,P=0.543];but on day 14,the nasal jejunal tube group had significantly higher levels of ALP,γ-GGT,and ALB compared with the nasogastric tube group [(201.2 ± 15.2) U/L vs.(116.5 ± 13.6) U/L,t =-25.380,P =0.000;(109.4±7.2) U/Lvs.(49.2±6.5) U/L,t=-37.665,P=0.000;(37.2±7.1) g/Lvs.(30.1±6.5) g/L,t =-4.490,P =0.000].On day 7 and day 14,there were no statistically significant differences in totalbilirubin [(4.6±0.9) μmol/L vs.(4.8 ± 1.0) μmol/L,t =-0.905,P=0.368;(4.8±12) μmol/Lvs.(5.2±1.1) μmol/L,t=-1.492,P=0.140],indirect bilirubin [(6.1 ±0.8) μmol/Lvs.(6.3±0.9) μmol/L,t=-1.012,P=0.315;(6.9±0.9) μmol/L vs.(7.3±1.0) μmol/L,t=-1.811,P =0.074],and direct bilirubin [(4.0 ± 0.6) μmol/L vs.(3.9 ± 0.5) μmol/L,t =0.777,P =0.440;(5.1 ±0.8) μmol/L vs.(5.4±0.9) μmol/L,t=-1.517,P=0.134] between the nasogastric tube and the nasal jejunal tube groups.The incidence of pulmonary infection in the nasal jejunal tube group was significantly lower than that in the nasogastric tube group (30.56％ vs.55.26％,x2 =4.598,P =0.032).Conclusion Compared with enteral nutrition through nasogastric tube,enteral nutrition through nasal jejunal tube may be more likely to lead to abnormal liver function.
