围手术期营养支持对肝移植患者蛋白质代谢及免疫功能的影响

Effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation

目的探讨肝移植患者围手术期不同营养支持方案对术后患者蛋白质代谢及免疫功能的影响。方法回顾性收集青岛大学附属医院器官移植中心于2015年3月至2016年3月期间收治的80例行肝移植手术的患者,根据营养支持方案分为对照组40例和观察组40例。对照组患者术前未行营养支持,术后排气前给予全胃肠外营养支持,待肛门排气后开始给予肠内营养支持;观察组患者术前给予营养支持,术后排气前给予静脉营养以及肠内营养支持。比较2组患者术前、术后7 d及术后14 d的蛋白质代谢及免疫学指标。结果 1蛋白质代谢指标。无论在对照组还是在观察组患者中,术后14 d患者的前白蛋白、转铁蛋白及累计氮平衡值均高于术前及术后7 d相应指标(P<0.05);术前2组患者的前白蛋白、转铁蛋白及累计氮平衡值比较差异均无统计学意义(P>0.05);术后7 d和14 d时,观察组患者的前白蛋白、转铁蛋白及累计氮平衡值均高于对照组(P<0.05)。2免疫学指标。无论在对照组还是在观察组患者中,术后14 d患者的淋巴细胞总数、IgG水平及CD_4/CD_8值均优于术前及术后7 d相应指标(P<0.05)。术前2组患者的淋巴细胞总数、IgG水平及CD_4/CD_8值比较差异均无统计学意义(P>0.05);术后7 d和14 d时,观察组患者的淋巴细胞总数、IgG水平及CD_4/CD_8值均优于对照组(P<0.05)。结论肝移植围手术期加强营养支持,可以防治肝移植患者代谢紊乱及营养不良的发生,提高患者的免疫功能。

Objective To study the effect of perioperative nutritional support on protein metabolism and immunity in patients underwent liver transplantation. Methods A total of 80 patients who underwent liver transplantation in our hospital from March 2015 to March 2016 were collected retrospectively, and then the 80 patients were divided into control group （n=40） and observation group （n=40） according to the type of perioperative nutritional support. Patients of control group didn＇t receive preoperatively nutritional support, and received total parenteral nutrition support before postoperative exhaust, then received enteral nutrition support after anal exhaust. Patients of observation group receive preoperatively nutritional support before surgery, and received parenteral nutrition and enteral nutrition support before postoperative exhaust. The several parameters about nutritional status and immune function were observed on 7 days and 14 days after liver transplantation, and comparison of the 2 group in these parameters was performed. Results On the protein metabolism, the levels of serum transferrin, prealbumin, and nitrogen balance on 14 days after liver transplantation were higher than those of other time points （before liver transplantation and 7 days after liver transplantation）, P〈0.05, both in control group and observation group. There was no significant difference in the levels of serum transferrin, prealbumin, and value of nitrogen balance between the 2 groups before liver transplantation （P〉0.05）, But on 7 days and 14 days after liver transplantation, the levels of serum transferrin, prealbumin, and value of nitrogen balance of the observation group were higher than those of control group （P〈0.05）. On the immunity, the total number of lymphocytes, value of IgG and CD4/CD8 on 14 days after liver transplantation, were superior to other time points （before liver transplantation and 7 days after liver transplantation）, P〈0.05, both in control group and observation group. There was no significant difference in the total number of lymphocytes, value of IgG and CDJCD~ between the 2 groups before liver transplantation （P〉0.05）. But on 7 days and 14 days after liver transplantation, the levels of the total number of lymphocytes, value of IgG and CD4/CD8 in the observation group were superior to those of control group （P〈0.05）. Conclusion Perioperative nutritional support can improve the nutritional status and immune function in patients underwent liver transplantation.