腹腔开放患者的肠内营养支持

Enteral nutrition support in 21 patients after opening abdomen

目的观察腹腔开放患者能否安全有效地应用肠内营养(EN)。方法回顾近3年因腹腔间室综合征行腹腔开放的患者的临床资料。通过空肠行 EN 支持超过3d 者入选。所有患者腹腔敞开后均以聚丙烯网覆盖,根据肠功能恢复情况,决定 EN 开始时机和方案。采用输注泵连续输注,分别于 EN 前和结束时检测血浆蛋白水平和氮平衡。使用 Harris-Benedict 方程式计算或间接能量测定仪测定实际能量消耗和呼吸商。结果 21例患者 EN 实施时间平均(51.5±33.6)d,开始于腹腔开放后(8.8±5.5)d,达到目标值的93%～95%。治疗前血各项蛋白水平低于正常值,但经过 EN支持后均有改善,其中纤维连接蛋白增加明显,相关并发症未有增加。结论腹腔开放患者肠管虽外露,但在感染得到控制,外加聚丙烯网的覆盖情况下,及时给予 EN,肠黏膜和肠壁组织获得营养和循环改善,使组织修复功能趋向健康。EN 可以安全有效地应用于腹腔开放的患者。

Obejective To evaluate the feasibility and efficacy of enteral nutrition（EN） in patients underwent open-abdomen managements. Methods Twenty-one patients who received at least 3 days of EN after opening the peritoneal cavity between January 2003 and November 2006 were included in this study. Energy expenditure and actual caloric and protein intake were determined in some patients. The levels of serum protein and nitrogen balance before and after the EN were analyzed. Other related complications were also evaluated. Results Average daily total caloric intake was 93%-95% of estimated needs. The EN support was administered （8. 8 ±5.5） d after opening the abdominal cavity and lasted for （51.5 ±33.6） d. Initial serum protein levels were low and below normal but increased in all of the patients after the EN. The average nitrogen balance was （ - 28.6 ± 5.4 ） g/d. Diarrhea, gastric reflux, vomiting and abdominal distention occurred in 67%, 23%, 9. 5% and 23% of the patients, respectively. All the complications were managed well. Conclusions EN support could be effectively and safely given in patients requiring opening peritoneal cavity management.