腹部严重创伤病人术后早期肠内营养的临床应用

The clinical application of early enteral nutrition in post-operative patients with severe abdominal trauma

目的研究术后早期肠内营养对腹部严重创伤病人的临床疗效及安全性、可行性。方法将30例腹部严重创伤的病人随机分为两组,肠内营养(EN组)和肠外营养(PN组),PN组术后行TPN支持。EN组术后第一天起经鼻饲管输注能全力,剂量由500mL/天递增至1500mL/天。分别于术前及术后2、8天测定血生化、血清蛋白、血红蛋白、免疫球蛋白,临床观察生命体征、胃肠道功能恢复情况及各种不良反应。结果①术后患者血清白蛋白、前白蛋白、转铁蛋白及免疫球蛋白均有不同程度的下降;②经PN和EN支持后,各项指标恢复到术前水平,EN组部分升高明显,对比有显著差异(P<0.05),③EN组肛门排气时间较PN组显著缩短(P<0. 05)。结论腹部严重创伤病人术后早期肠内营养安全、可行;在改善机体的营养状态及免疫功能方面,其作用优于肠外营养;同时可促进胃肠道功能的恢复。

Objectives To explore the feasibility and safety of early post-operative enteral nutrition (EN) for patients with severe abdominal trauma. Methods 30 patients with severe abdominal trauma were at random divided into two groups: enteral nutrition group (EN group) and parental nutrition group (PN group). PN group was given total parental nutrition (TPN). In the EN group, since the first post-operative day Neutrinos(r) was infused, the infused volume was increasingly added from 500mL/d to 1500mL/d. Parameters including the serum biochemical index, plasma protein, Hb and immunoglobulin were measured before operation and on the 2nd, 8th post-operative day. The vital signs, resumption of gastrointestinal function and complications were carefully observed. Results (1) The levels of serum albumin, pre-albumin, transferrin and immunoglobulin were to varying degrees decreased. (2) All parameters returned to pre-operative levels after EN and PN support. Some parameters (EN group) were obviously different from PN group's (P<0.05). (3) The bowel movement resumed significantly earlier in the EN group than in the PN group(P<0.05). Conclusions Early EN for post-operative is safe and feasible. EN is superior to PN in terms of improvement of the nutritional status and the immune function. Moreover, it helps to promote the resumption of gastrointestinal function.