门静脉途径胃肠外营养在腹部中等手术后的应用

Application of parental nutrition via portal vein during postoperative period of moderate abdominal operations

目的探讨门静脉途径胃肠外营养(PN-pv)在腹部中等手术后短期营养支持的可行性;与中心静脉途径胃肠外营养(PN-cv)进行腹部中等手术后代谢影响及营养支持效果的比较。方法研究对象为19例因慢性胆囊炎、胆囊结石行胆囊切除术的病人,随机分为两组:门静脉途径胃肠外营养组,中心静脉途径胃肠外营养组,手术后第一天起两组分别接受门静脉途径、中心静脉途径等氮、等热卡胃肠外营养支持3天。结果营养支持3天后(1)PN-pv 组血清胰岛素水平显著高于 PN-cv 组(P<0.05);(2)PN-pv 组血清葡萄糖水平显著低于 PN-cv 组(P<0.01);(3)PN-pv 组血清前白蛋白水平显著高于 PN-cv 组(P<0.05)。结论①门静脉途径胃肠外营养在腹部中等手术后的短期营养支持是可行的;②门静脉途径胃肠外营养支持的效果优于中心静脉途径,且糖代谢稳定并因此可以减少代谢并发症的发生。

Objective Based on results of animal experiment,we conducted the clinical experi- mental study of parenteral nutrition via portal vein(PN-pv).The aim of this study is to evaluate the fea- sibility of PN-pv in postoperative period of moderate abdominal operations and the relative efficacy of portal and central venous infusion of PN.Methods Nineteen patients with chronic cholecystitis were divided randomly into two groups:10 patients received PN via portal vein(PN-pv Group)and 9 patietns received PN via central vein(PN-cv Group).The same nutritional support for the 19 patients of both groups began from the first day following operation and continued for the next 3 days.Results (1)The serum level of insulin in PN-cv Group was significantly higher than that in PN-cv Group(p <0.05);(2)The serum level of glucose in PN-pv Group was significantly lower than that in PN-pv Group(p<0.01);(3)The serum level of prealbumin in PN-pv Group was significantly higher than that in PN-cv Group(p<0.05).Conclusion PN pv support after moderate abdominal operations is feasible and metabolically superior to PN-cv.It can reduce the metabolic complications.Its nutritional effect is also superior to PN-cv.