胰十二指肠切除术后早期肠内营养对患者营养状态及炎症反应的影响

Effects of early enteral nutrition on the nutritional indicators and inflammatory response in patients after pancreaticoduodenectomy

目的观察早期肠内营养对胰十二指肠切除术PD后患者营养状态及炎症反应的影响。方法将46例PD患者根据营养支持方式随机分为肠外营养(PN)组和早期肠内营养(EEN)组,每组23例,术后24h开始分别接受PN和EN支持,观察两组患者术后1、7、14d的营养状态及炎症反应变化。结果术后7d与术后14d两组患者的血红蛋白、血清总蛋白、白蛋白、前白蛋白水平较术后1d均明显提高(P均<0.05),术后14dEEN组患者的血红蛋白、血清总蛋白、白蛋白水平较术后7d也明显提高(P均<0.05),且EEN组术后7d血清前白蛋白的水平及术后14d血红蛋白、血清总蛋白、血清白蛋白的水平均高于PN组(P均<0.05)。EEN组患者术后7d与术后14d的血清TNF-α、IL-1β、IL-8水平均明显低于前次测定值(P均<0.05),也低于PN组(P均<0.05)。两组患者术后均出现SIRS,EEN组SIRS持续时间为(3.62±1.36)d,PN组为(5.78±1.64)d,两组比较差异有统计学意义(P<0.05)。EEN组术后MODS发病率(13.04%)明显低于PN组(26.08%)(P<0.05)。EEN组患者感染相关并发症发生率也低于PN组(P<0.05),肠鸣音恢复时间、肛门排气时间短于PN组(P<0.05),而术后营养支持费用PN组高于EEN组(P<0.05)。结论 PD术后早期EN在改善患者的营养状态、减轻炎症反应、促进肠道恢复、减少术后感染并发症方面都优于PN,并能降低营养支持费用。

Objective To observe the effects of early enteral nutrition on the nutritional indicators and inflammatory response in patients after panereaticoduodenectomy.Methods According to random table,46 cases of postoperative patients with pancreatieodundenectomy were divided into two groups accepting early enteral nutritional support or parenteral nutritional support respectively.Indexes of the nutritional indicators and inflammatory response were measured on the postoperative day 1,7 and 14.At the same time,the clinical conditions of patients with SIRS and MODS were observed and analyzed.Results The hemoglobin,serum total protein,serum albumin and prealbumin were significantly improved on the 7th and 14th day in both groups compared with the first day(all P<0.05).On the 7th day the levels of serum prealbumin were significantly higher in early enteral nutrition(EEN)group than in parenteral nutrition(PN)group,and on the 14th day the levels of hemoglobin,serum total protein,albumin were significantly higher in EEN group than in PN group(all P<0.05).Patients in both groups had acute inflammatory response after pancreaticoduodcnectomy.On the 7th and 14th day,the levels of tumor necrosis factor-α,interleukin(IL)-1β,and IL-8 in EEN group were significantly lower than those in PN group and the first day levels(all P<0.05).The duration of SIRS in EEN group was significantly shorter than that in PN group.The morbidity of MODS was significantly lower in EEN group than that in PN group(P<0.05).Conclusions EEN after pancreaticoduodenectomy can positively modulate the acute inflammatory response,decrease the morbidity of MODS,improve the levels of nutritional indicators and decrease nutritional costs.