肠内、肠外营养对胃大部切除术后患者胃肠激素水平的影响

Influence of Enteral vs. Parenteral Nutrition on Gut Hormones after Subtotal Gastrectomy

背景:术后早期肠内营养(EN)越来越受到临床医师的重视,但早期EN对胃大部切除术后患者胃肠激素水平的影响研究较少。目的:通过对胃大部切除术后患者胃肠激素水平的检测,为术后早期应用EN提供依据。方法:将41例拟择期行胃大部切除术的患者随机分为EN组(n=20)和肠外营养组(PN组,n=21),术后第1～7d分别给予EN或PN支持治疗。于术前、术后第1、7d清晨分别测定患者血清胃泌素(GAS)、血浆胃动素(MTL)、血浆胆囊收缩素(CCK)水平。结果:41例胃大部切除患者术后第1d血清GAS、血浆MTL和CCK水平较术前显著下降(P<0.01),术后第7d恢复至术前水平。EN组术后第7d血浆MTL、CCK水平显著高于PN组(P<0.05和P<0.01),而两组血清GAS水平无显著差异(P>0.05)。结论:胃大部切除术后应用EN制剂能增加患者血浆MTL和CCK水平,有助于促进残胃动力功能的恢复,促进胃肠道消化和吸收,促进胆囊收缩,预防胆汁淤积等胆囊疾病的发生。

Background： Currently, clinicians have paid more and more attention to early enteral nutrition （EN） after surgical operation, but there is scanty study on the relationship between EN and gut hormones after subtotal gastrectomy. Aims： To provide evidences for giving early EN after subtotal gastrectomy by measuring patients＇ blood gut hormones. Methods： Forty-one patients underwent elective subtotal gastrectomy were randomly divided into EN group （n=20） and parenteral nutrition （PN） group （n=21）. From the first day after operation to the seventh day, patients received either EN （EN group） or PN （PN group） supportive therapy. Serum gastrin （GAS）, plasma motilin （MTL） and plasma cholecystokinin （CCK） were measured on the day before operation, the first day and the seventh day after operation. Results： Compared to the preoperative levels, the serum GAS, plasma MTL and CCK levels of all 41 patients decreased significantly on the first day after subtotal gastrectomy （P〈0.01）, but returned to the preoperative levels one week later. On the seventh day after subtotal gastrectomy, the plasma MTL and CCK levels in EN group were higher than those in PN group （P〈0.05 and P〈 0.01, respectively）, but there was no difference in GAS level between the two groups （P〉0.05）. Conclusions： Plasma MTL and CCK levels in EN group are higher than those in PN group. EN thus can promote the recovery of gastrointestinal motility, digestion and absorption, and may prevent some gallbladder diseases such as cholestasis.