风湿性瓣膜病心脏恶液质综合征患者围手术期应用胃肠内营养64例

Perioperative enteral nutrition in rheumatic valve disease patients with cardiac cachexia:A report of 64 cases

目的：观察胃肠内营养对心脏恶液质综合征患者手术后并发症发生率和远期生存率的影响。方法：①选择1999-08/2005-09首都医科大学附属北京安贞医院心脏外科收治的风湿性瓣膜病心脏恶液质综合征患者围手术期应用胃肠内营养64例,均对营养措施知情同意。②围手术期皆应用胃肠内营养,2.1～4.2mJ/d;营养成分中,蛋白质∶脂肪∶糖=3∶6∶11,选用非整蛋白制剂作为胃肠内营养的主要原料,每晚应用含有大量活性双歧杆菌的酸奶封闭胃管。③采用电话与信函相结合方式对患者手术后生存率和心脏功能进行随访。共随访60个月。结果：64例3例失访,余随访60个月。1年生存率79%,3年生存率61%,5年生存率57%。术后心脏功能得到改善,心功能级别提高1-2级,体质量增加10%-30%。术后并发症13例（20%）,死亡4例（6%）。结论：围手术期应用胃肠内营养可以降低风湿性瓣膜病心脏恶液质综合征患者围手术期死亡率及并发症的发生率,提高远期生存率。

AIM： To summarize the clinical effect of enteral nutrition （EN） on the morbidity of postoperative complication and long-term life quality of rheumatic valve disease patients with cardiac cachexia. METHODS： ①This report reviewed 64 cases of rheumatic valve disease with cardiac cachexia treated in the Department of Cardiac Surgery. Anzhen Hospital. Capital University of Medical Sciences from August 1999 to September 2665. They were all informed of nutrition management and then consented.②All the patients were treated with EN perioperatively with the dosage of 2.1-4.2 m J/d, Among the nutrition, the ratio of protein, fat and sugar was 3：6：11. with no-intact protein, All the patients were closed stomach by yogurt with bifidobacterium every night. ③ A 60-month follow-up was conducted by use of phone and letter for the postoperative survival rate and cardiac function of patients. RESULTS： Due to three cases were lost in the follow-up, sixty-one patients were analyzed for 60 months. The survival rate was 79% at one-year follow-up, 61% at 3-year follow-up, and 57% at 5-year follow-up, The NYHA cardiac function was improved 1-2 degree and the weight increased 16%-30%. Four patients （6%） died and 13 cases （26%） occurred postoperative complication. CONCLUSION： EN can reduce the perioperative mortality and the morbidity of complication, moreover, enhance the long-term life quality of rheumatic valve disease patients with cardiac cachexia.