胰十二指肠切除术后患者营养支持的护理

Clinical Care of Parenteral Nutrition and Enteral Nutrition Support on Post-pancreatoduodenectomy Patients

目的总结胰十二指肠切除术(PD)后患者肠外营养(PN)和肠内营养(EN)的护理体会。方法回顾性分析了48例接受胰十二指肠切除术患者的临床资料,围手术期应用肠内外营养患者22例(治疗组),单独予以肠外静脉营养患者26例(对照组),所有患者均于术前接受中心静脉置管,术中行空肠造瘘,术后给予PN和EN或TPN支持。结果治疗组手术前后总蛋白和白蛋白改善情况均优于对照组(P<0.05)。治疗组的术后并发症发生率,手术前后体质量变化及总蛋白改善情况及术后并发症的发生率均优于对照组(P<0.05)。所有病例共出现中心静脉导管脱出和堵塞各2例、空肠造瘘未出现导管并发症、18例出现糖代谢严重异常。结论胰十二指肠切除术后联合PN和EN疗效优于TPN,护理治疗中应坚持严格管路护理、无菌配液、密切观察血糖变化和加强心理护理。

Objective To explore the clinical care experience of parenteral nutrition （PN） and enteral nutrition（EN） support on patients who have undergone pancreatoduodenectomy. Methods We retrospectively analyzed the clinicaldata of 48 patients who received PN and EN support by centralvenous catheter and jejunostomy after pancreatoduodenectomy. In two groups of patients, compare with weight changes, total protein and albumin status, hospital time and costs, and postoperative complication rate and other indicators. Results Before PD, the status of the total protein and albuminin in the treatment group are better than that in the control group （P〈0.05）. The postoperative complication rate, body weight changes and total protein status in treatment group are better than that in the control group （P〈0.05）. In all cases, 2 patients had catheterocclusion, 2 patients had catheter dis-location, and no patients had jejunostomy-related complications,18 patients had severe disorder in glucoseme-tabolism. Conclusions PN and EN combined support is important for patients after pancreatoduodenectomy. Clinical care of PN and EN should ensure sterility of the nutritional emulsions, strengthen tubemaintenance, monitor clearly blood glucose changes, and enhance psychologicalnursing.