短期低氮低热卡肠外营养在术后患者的应用评价

Evaluation of short-term TPN with low nitrogen and hypo-calorie on postoperative surgical patients

目的研究术后短期低氮低热卡肠外营养对胃肠肿瘤患者体重、血糖、急性相反应蛋白及感染并发症的影响。方法64例行胃肠肿瘤根治术患者随机分为两组，即研究组（低氮低热卡）和对照组（标准热氮卡）各32例。术后第2～7天进行肠外营养支持。监测术前和术后第2、4、8天血糖、急性相反应蛋白（CRP）、转氨酶（ALT、AST）的变化，于术前及术后第8天测体重。结果两组患者术后第2天血糖均明显升高，术后第4、8天血糖和CRP研究组仍升高，但较对照组减少（P〈0．05），术后第8天研究组的血糖、CRP均恢复正常，而对照组下降缓慢，两组间转氨酶（ALT、AST）和体重变化差异无统计学意义（P〉0．05）。对照组感染相关并发症较研究组高（P〈0．05）。结论胃肠术后短期低氮低热卡肠外营养有利于患者血糖和创伤应激反应的恢复，可能会减少感染相关并发症。

Objective To study the effect of shortterm total parenteral nutrition （TPN） with hypo- calorie and nitrogen on body weight, blood glucose, C- response protein （CRP） of the post- operative surgical patients with gastrointestinal cancer. Methods Sixty - four patients undergoing radical operation for carcinoma of gastrointestine were randomized into standard caloric and nitrogenic groups （control group, n = 32） and hypo-calorie and low nitrogen group （study group, n = 32）. They received standard TPN and low nitrogenic/hypocaloric TPN support from postoperative day 2 to 7. Blood glucose,CRP and transaminase （ALT,AST） were examined before and 2,4,8 days after operation. The body weight was measured before and 8 days after operation, Results On the second postoperative day, blood glucose and CRP were increased significantly in all the eases. On the 4th and 8th postoperative day, blood glucose and CRP were also increased as compared with those preoperation in study group, but reduced as compared with control group. On the 8th day after operation,in study group, CRP and blood glucose returned to normal level. In contrast, blood glucose and CRP were slowly reduced in control group. The changes in body weight and ALT and AST between two groups showed no statistically significant difference. In control group,infection- related complications were increased as compared with study group. Conclusion In postoperative patients,shortterm TPN support with low nitrogen and hypo- calorie can decrease blood glucose and CRP level, and possibly decrease significantly infection - related complications.