CAJ | 학술논문

目的：探讨早期肠内营养对重症肝炎肝移植患者术后恢复的影响。方法本前瞻性研究对象为2012年6月至2014年4月在中山大学附属第三医院行同种异体原位肝移植的32例重症肝炎患者。所有患者均签署知情同意书，符合医学伦理学规定。采用随机数字表法将患者随机分为肠内营养组和肠外营养组。其中肠内营养组14例，均为男性；平均年龄（42±9）岁。肠外营养组16例，男14例，女2例；平均年龄（44±10）岁。肠内营养组术后1 d经胃空肠管注入温水、乳果糖，术后2 d开始使用肠内营养混悬液，并逐渐加量至1000 ml/d，同时逐步减少肠外营养；肠外营养组术后即给予肠外营养，两组均待肠道功能完全恢复后开始正常饮食。分别于术前、术后1、10 d抽取静脉血检测两组患者肝肾功能。观察患者术后2周内胃肠道功能恢复情况、肝肾功能及感染发生情况。两组观察指标比较采用t检验或秩和检验，率的比较采用Fisher确切概率法。结果肠内营养组患者术后胃肠道功能恢复时间为（6.1±1.4）d，明显短于肠外营养组的（10.6±3.8）d（t=-4.21，P<0.05）。肠内营养组患者术后10 d的ALT、AST、TB、前白蛋白、尿素氮（BUN）中位数分别为106（50～163） U/L、62（27～135） U/L、67（35～116）μmol/L、201（105～389） mg/L、12.5（6.4～18.8）mmol/L，与肠外营养组的276（46～716）U/L、119（33～447）U/L、131（89～391）μmol/L、162（103～238）mg/L、26.1（12.9～37.6）mmol/L比较差异有统计学意义（Z=-3.76，-3.15，-4.01，2.93，-3.79；P<0.05）。术后2周内肠内营养组感染发生率为43%（6/14），明显低于肠外营养组的69%（11/16）（P<0.05）。结论与肠外营养相比，肝移植术后早期肠内营养能促进患者胃肠道功能恢复、改善肝肾功能和营养状态，降低术后感染发生率，有利于术后恢复。目的：探討早期腸內營養對重癥肝炎肝移植患者術後恢複的影響。方法本前瞻性研究對象為2012年6月至2014年4月在中山大學附屬第三醫院行同種異體原位肝移植的32例重癥肝炎患者。所有患者均籤署知情同意書，符閤醫學倫理學規定。採用隨機數字錶法將患者隨機分為腸內營養組和腸外營養組。其中腸內營養組14例，均為男性；平均年齡（42±9）歲。腸外營養組16例，男14例，女2例；平均年齡（44±10）歲。腸內營養組術後1 d經胃空腸管註入溫水、乳果糖，術後2 d開始使用腸內營養混懸液，併逐漸加量至1000 ml/d，同時逐步減少腸外營養；腸外營養組術後即給予腸外營養，兩組均待腸道功能完全恢複後開始正常飲食。分彆于術前、術後1、10 d抽取靜脈血檢測兩組患者肝腎功能。觀察患者術後2週內胃腸道功能恢複情況、肝腎功能及感染髮生情況。兩組觀察指標比較採用t檢驗或秩和檢驗，率的比較採用Fisher確切概率法。結果腸內營養組患者術後胃腸道功能恢複時間為（6.1±1.4）d，明顯短于腸外營養組的（10.6±3.8）d（t=-4.21，P<0.05）。腸內營養組患者術後10 d的ALT、AST、TB、前白蛋白、尿素氮（BUN）中位數分彆為106（50～163） U/L、62（27～135） U/L、67（35～116）μmol/L、201（105～389） mg/L、12.5（6.4～18.8）mmol/L，與腸外營養組的276（46～716）U/L、119（33～447）U/L、131（89～391）μmol/L、162（103～238）mg/L、26.1（12.9～37.6）mmol/L比較差異有統計學意義（Z=-3.76，-3.15，-4.01，2.93，-3.79；P<0.05）。術後2週內腸內營養組感染髮生率為43%（6/14），明顯低于腸外營養組的69%（11/16）（P<0.05）。結論與腸外營養相比，肝移植術後早期腸內營養能促進患者胃腸道功能恢複、改善肝腎功能和營養狀態，降低術後感染髮生率，有利于術後恢複。
목적：탐토조기장내영양대중증간염간이식환자술후회복적영향。방법본전첨성연구대상위2012년6월지2014년4월재중산대학부속제삼의원행동충이체원위간이식적32례중증간염환자。소유환자균첨서지정동의서，부합의학윤리학규정。채용수궤수자표법장환자수궤분위장내영양조화장외영양조。기중장내영양조14례，균위남성；평균년령（42±9）세。장외영양조16례，남14례，녀2례；평균년령（44±10）세。장내영양조술후1 d경위공장관주입온수、유과당，술후2 d개시사용장내영양혼현액，병축점가량지1000 ml/d，동시축보감소장외영양；장외영양조술후즉급여장외영양，량조균대장도공능완전회복후개시정상음식。분별우술전、술후1、10 d추취정맥혈검측량조환자간신공능。관찰환자술후2주내위장도공능회복정황、간신공능급감염발생정황。량조관찰지표비교채용t검험혹질화검험，솔적비교채용Fisher학절개솔법。결과장내영양조환자술후위장도공능회복시간위（6.1±1.4）d，명현단우장외영양조적（10.6±3.8）d（t=-4.21，P<0.05）。장내영양조환자술후10 d적ALT、AST、TB、전백단백、뇨소담（BUN）중위수분별위106（50～163） U/L、62（27～135） U/L、67（35～116）μmol/L、201（105～389） mg/L、12.5（6.4～18.8）mmol/L，여장외영양조적276（46～716）U/L、119（33～447）U/L、131（89～391）μmol/L、162（103～238）mg/L、26.1（12.9～37.6）mmol/L비교차이유통계학의의（Z=-3.76，-3.15，-4.01，2.93，-3.79；P<0.05）。술후2주내장내영양조감염발생솔위43%（6/14），명현저우장외영양조적69%（11/16）（P<0.05）。결론여장외영양상비，간이식술후조기장내영양능촉진환자위장도공능회복、개선간신공능화영양상태，강저술후감염발생솔，유리우술후회복。
ObjectiveTo investigate the effects of early enteral nutrition on the recovery of patients with severe hepatitis after liver transplantation (LT).MethodsThirty-two patients with severe hepatitis undergoing allogeneic orthotopic LT in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and April 2014 were included in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were randomized into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Among the 14 patients in the enteral nutrition group, all patients were males with the average age of (42±9) years old. Among the 16 patients in the parenteral nutrition group, 14 were males and 2 were females with the average age of (44±10) years old. Patients in the enteral nutrition group were given warm water and lactulose through gastro-jejunal tube 1 d after LT. Enteral nutritional suspension was offered 2 d after LT and gradually increased to 1 000 ml/d, meanwhile, parenteral nutrition was reduced gradually. Patients in the parenteral nutrition group were given parenteral nutrition. Patients in both groups started normal diet after full recovery of the intestinal function. Venous blood was collected before LT and 1, 10 d after LT to examine hepatic and renal function. The recovery of gastroenteric function, hepatic and renal function and incidence of infection were observed 2 weeks after LT. The comparison of the observed indexes of two groups was conducted usingt test or rank-sum test and the rate comparison was conducted using Fisher's exact test.Results The postoperative recovery time of gastroenteric function of the enteral nutrition group was (6.1±1.4) d, which was significantly shorter than (10.6±3.8) of the parenteral nutrition group (t=-4.21,P<0.05). The median ALT, AST, TB, prealbumin and blood urea-nitrogen (BUN) in the enteral nutrition group 10 d after LT were respectively 106 (50-163) U/L, 62 (27-135) U/L, 67 (35-116) μmol/L, 201 (105-389) mg/L and 12.5 (6.4-18.8) mmol/L, and those in the parenteral nutrition group were respectively 276 (46-716) U/L, 119 (33-447) U/L, 131 (89-391) μmol/L, 162 (103-238) mg/L and 26.1(12.9-37.6) mmol/L. Signiifcant difference was observed (Z=-3.76,-3.15,-4.01, 2.93,-3.79;P<0.05). The incidence of infection of the enteral nutrition group 2 weeks after LT was 43% (6/14), which was signiifcantly lower than 69% (11/16) of the parenteral nutrition group (P<0.05). ConclusionCompared with parenteral nutrition, early enteral nutrition after LT may promote the recovery of gastroenteric function, improve the hepatic and renal function and nutritional situation and reduce the incidence of postoperative infection, which is beneficial to postoperative recovery.