克罗恩病的围手术期营养支持

Perioperative nutrition support in patients with Crohn's disease

目的:探讨围手术期营养支持对克罗恩病(CD)手术治疗的应用价值和经验。方法:回顾性分析因CD相关并发症而进行手术的150例次病人,对病人的营养指标、CD病变活动度指标、病变部位、手术原因、手术方式、术前及术后营养支持应用情况、手术相关并发症等进行相关统计。结果:有130例病人入院时即存在营养不良(86.67%),表现为体质指数(BMI)<18.5或近3个月体质量下降10%以上。围手术期营养支持后病人术前和出院时Hb、ALB、PA、TF和淋巴细胞计数等较入院时均显著改善,但BMI增加不明显。53例病人出院后继续行家庭EN,3个月后平均BMI显著增加(19.24vs17.64,P<0.001)。136例手术获得成功,14例发生手术相关并发症,其中2例死亡。2例危重病人采取损伤控制性手术原则联合营养支持救治成功。出院时,病人病变活动度(CDAI)评分、C-反应蛋白(CRP)水平、红细胞沉降率(ESR)均较入院时显著下降。结论:围手术期营养支持对改善CD病人的预后具有积极的意义。对于危重CD病人采用损伤控制性手术,能取得较好的治疗效果。

Objective： To investigate the potential role and our experience of perioperative nutritional support in the management of patients with Crohn＇s disease （CD）. Methods： 150 CD patients （male to female = 101：49） performed with operation and from the year 1997 to 2007 were analyzed retrospective ly. Their nutritional index, Crohn＇s Disease Activity Index （CDAI）, sites of lesion, causes and procedures of operation, usage of nutritional support pre-operatively and post-operatively, and operation-related complications were all recorded. Results： Malnutrition, as indicated as BMI 〈 18.5 kg/m^2 or decrease of body weight 〉 10% over the recent 3 months ,occurred in 130 patients （88.67%）on admission. After aggressive nutritional support, patients＇ nutritional index, such as blood haemoglobin, serum albumin,pre-albumin, transferrin and lymphocytes counts all increased significantly pre-operatively and on discharge compared with on admission, while the change of BMI was not significant. For 53 patients receiving home enteral nutrition after discharge, their BMI increased significantly on last follow-up compared with on admission （ 19.24 vs 17.64, P 〈 0. 001 ）. Operation-related complications occurred in 14 patients （9.33%）, and two of them died due to severe intra-abdominal infections. Two patients with severe retroperitoneal infection on admission were successfully treated using the damage-control surgery. Conclusion： Malnutrition is a common complication in CD patients receiving surgery, and aggressive perioperative nutritional support may have a positive effect on the morbidity and mortality in such patients. Long-term maintenance therapy with enteral nutrition may delay the postoperative recurrence of the Crohn disease and should be considered. For critically ill CD, damage-control surgery may get a better outcome than conventional treatment procedures.