肝移植术后早期肠内营养支持的安全性和有效性

Safty and Efficiency of Early Enteral Nutrition in Patients after Liver Transplantation

目的比较早期肠内营养(EN)和胃肠外营养(PN)支持对维持和改善肝移植术后病人营养状态的作用及其安全性。方法肝移植术后进行营养支持的患者40例,随机分为EN组和PN组(各20例),两组营养支持均为等热量和等氮量。分别于术前、术后第1和第8天检测营养指标,测定每日氮平衡并计算累计氮平衡,观察术后感染率和营养支持并发症的发生率。结果术后第8天,EN组白蛋白显著高于PN组,γ-谷氨酰转肽酶、碱性磷酸酶和血糖水平明显低于PN组(P<0.05);术后第3天起,两组间每日氮平衡和累计氮平衡均有差异显著(P<0.05,P<0.01);EN组血液、肺部、消化道等感染率显著低于PN组(P<0.05);EN组营养支持无严重并发症发生,其肛门排气时间明显短于PN组(P<0.01),平均营养支持费用也明显少于PN组(P<0.01)。结论肝移植术后EN是安全可行的。与PN支持相比,EN可更有效地改善病人的术后营养状态,促进移植肝功能的恢复,同时减少术后感染并发症的发生,降低住院费用,具有明显的优越性。

Objective To evaluate the efficiency and safety of early enteral nutrition in patients after liver transplantation. Methods A randomized controlled clinical trial was conducted to compare the role of early enteral nutrition（EN） with parenteral nutrition（PN） in 40 patients after liver transplantation. The intake was same in nitrogen and calorie between the two groups. Nutrition state tests before operation and at d 1 and d 8 after operation were analysed. Nitrogen balance was measured daily. The infection and complications of nutrion support were observed. Results The concentration of serum albumin in EN group was higher than that in PN group, while the concentrations of γ-glutamyl transpeptidase, alkaline phosphatase and blood glucose were lower than those in PN group （P 〈 0.05）.Nitrogen balance was better in EN group than that in PN group. The infection rate of blood, lung, and digestive tract in EN group were lower than those in PN group （P 〈 0.05）. There was no severe complications in EN group, and the time of gas passage by anus in EN group was shorter and the cost of nutrition was less than those in the PN group （P 〈0.01）. Conclusion EN was safe and feasible after liver transplantation. Campared with PN support, EN support can more efficiently ameliorate the nutrition state of the patients with liver transplantation, and accelerate the recovery of liver function. Besides, EN support can reduce the post-operative infection, and can decrease the cost in hospital.