消化道手术后早期肠内营养的临床研究

Early postoperative enteral nutrition support after digestive tract surgery

目的探讨消化道手术后早期进行肠内营养支持的可行性、安全性及临床效果。方法外科消化道手术后病人分成两组，肠内营养组接受能全力肠内营养，普通输液组接受以葡萄糖供能为主的治疗，共7天。术后第1天（应用前）和术后第8天测定血浆蛋白，肝肾功能、血糖、电解质、淋巴细胞计数，IgG、IgA、IgM，体重。临床观察肛门恢复排气时间，营养支持期间有无腹胀、腹痛、腹泻、恶心、呕吐等。结果肠内营养组血白蛋白，前白蛋白术后第8天明显增高，差别有统计学意义（P＜0．01）。肛门恢复排气时间，肠内营养组明显提前，两组比较差异有显著性（P＜0．01）。两组体重术后均有下降，研究组下降幅度明显小于对照组，差异有统计学意义（P＜0．01）。其它生化指标均在正常范围。肠内营养组不良反应发生率7．86％。结论术后早期肠内营养能促进胃肠功能恢复，改善营养状态，并且安全可行。

Objective To study the feasibility, safety and clinical effects of early postoperative enteral nutrition support after digestive tract surgery. Methods Thirty two patients were divided postoperatively into two groups. The enteral nutrition group (EN group, n = 22) received nutrison fibre enterally for 7 dsys and the control group(n = 10) received intravenous isotonic glucose solution and oral liquid diet after the bowel movement recovery. Liver and renal functions, plasma protein, glucose, electrolytes, total lymphocyte count, IgG, IgA, IgM and body weight were detected on day 1 (before EN) and day 8 (after EN) optopertively. The recovery of bowel movemen and other digestive Symptoms such as abdominal pain, distention, diarrhea, nausea and vomiting were for during the period of study. Results Serum albumin and prealbumin in the EN group were increased significantly (P<0.01). The recovery of bowel movement in EN group is much earlier than that in the control group. The body weights were decreased in both groups while it was less obvious in the EN group compared with the control group (P < 0.01). No other significant changes were noted in both groups. The complication rate was 7. 86% 1n EN group. Conclusions Early postoperative enteral nutrition could promote the recovery of gastrointestinal function and nutritional state. It is safe and feasibile.