肠外联合肠内营养支持在肝功能衰竭病人肝移植术后的应用

The effects of parenteral and enteral nutritional therapies in patients with liver failure undergoing liver transplantation

目的:观察肠外营养(PN)联合肠内营养(EN)对肝功能衰竭病人肝移植术后营养状况、肝功能和炎性反应的影响。方法:选择因肝功能衰竭行肝移植术后早期进行营养支持治疗的病人38例,随机分为试验组和对照组,每组19例。试验组病人术后行PN支持,待肠道通气后停止PN,改为正常饮食基础上增加EN支持;对照组病人术后行PN支持,待肠道通气后仅正常饮食。通过检测营养状态指标、肝功能和炎性指标,分析比较两种方法的疗效。结果:试验组病人术后14 d的体重和术后住院时间明显优于对照组(P<0.05);肝功能的恢复、前清蛋白水平的提高和C-反应蛋白下降均明显快于对照组(P<0.05)。结论:肝功能衰竭病人行肝移植术后PN联合EN支持,能改善机体的营养状态、降低炎性反应、促进肝细胞修复。

Objective： To investigate the effects of the combination of parenteral and enteral nutritionaltherapies on patients with liver failure after liver transplantation, including nutritional status, liver function and inflammatory reaction. Methods： A randomized clinical trial was conducted in 38 patients after orthotopic liver transplantation from Jan 2009 to December 2012. In the testing group, patients received parenteral nutrition and enteral nutrition. In the control group, patients received parenteral nutrition and then normal diet. The nutritional status, liver function and inflammatory reaction were compared between the two groups. Results： 38 patients were all successfully included. The body weight were significantly improved and the length of hospitalization were significantly reduced （P 〈 0.05 ） in the test group. The liver function and prealbumin level were significantly improved and C-reactive protein was significantly decreased （P 〈 0.05 ） in the test group. Conclusion ： The combination of parenteral and enteral nutrition can improve the nutrition rehabilitation, reduce the inflammatory reaction, and enhance the recovery of hepatocyte in patients with liver failure undergoing liver transplantation.