肠外全营养混合液对围手术期肝叶切除患者的疗效分析

The analysis of pareteral total nutrient admixture (TNA) effect on the patients with hepatolobectomy in perioperative period

目的研究分析肠外全营养混合液(TNA)对围手术期肝叶切除患者的疗效。方法33例行肝叶切除术的患者围手术期给予肠外TNA支持,术前营养支持(7.3±2.3)d,术后(10.4±2.4)d。观察患者营养指标、肝功能等的变化及术后并发症和病死率。结果术前TNA支持5d后,各营养观察指标已有明显增加;肝功能的各项指标都有所改善;电解质情况较营养支持前变化不大;淋巴细胞有显著增加;各凝血指标变化不大;血糖及血尿素氮有所降低。术后第10天(术后营养支持第7天),患者的体重及上臂肌围已恢复到营养支持前的水平并略有增加;血红蛋白与血红细胞基本恢复正常,而白蛋白虽较营养支持前有所增加但仍低于正常;肝功能有较大改善;电解质情况较营养支持前变化不大(主要是在治疗过程中采取了纠正措施);淋巴细胞有显著的增加;各凝血指标有所下降;血糖及血尿素氮都有较大幅度的上升。术后病死率和并发症发生率分别是0和24.2%。结论本实验TNA处中方含有薄芝糖肽、复合辅酶、甘露聚糖肽,有助于改善围手术期肝叶切除术患者的营养状况,有助于降低术后病死率和并发症发生率。

Objective To analyse the TNA curative effect on the patients with hepatolobectomy in Perioperarive period. Methods In 33 cases, patients under hepatolobectomy get the TNA support in perioperative period. They have the nutrition support for（7.3±2.3）days before hepatolobectomy and （10.4±2.4）days after hepatolobectomy. Observe the change of patient＇s nutrition objective, liver function, and the complications and death rate after hepatolobectomy. Results After 5 days of TNA support before hepatolobectomy, each nutrition index increases evidently; each liver function index ameliorates; electrolytes change little; lymphocytes increase evidently; each coagulation index changes little; blood sugar and BUN decrease. At the 10th day after hepatolobectomy（the 7th day of nutrition support）, the patient＇s avoirdupois weight and the muscle of upper arm return to the former and increase a little; haemoglobin and blood erythrocyte return to normol basically, the albumin increases but it is stiu less than the ordinary. Liver function improves greatly; electrolytes change little （because we adopt correcting measure for cure）; lymphocytes increase evidently; each coagulation index decreases; blood sugar and BUN increase greatly. After hepatolobectomy the death rate and syndrome are 0 and 24.2% respectively. Conclusion This TNA prescription contains BoZhi glycopeptide, compound coenzyme and mannatide peptide. They can help to improve nutrition status of the patients with hepatolobectomy in pefioperative period and reduce the death rate and complications after hepatolobectomy.