梗阻性黄疸术后早期肠内营养对全身炎症反应综合征的影响

Effects of early enteral nutrition on acute inflammatory response syndrome after operations for obstructive jaundice

目的观察早期肠内营养对梗阻性黄疸术后全身炎症反应综合征(SIRS)的影响。方法60例梗阻性黄疸患者,随机分为肠内营养(EN)组、肠外营养(PN)组和对照组,术后第1天开始分别接受肠内、肠外营养及普通输液治疗,测定3组患者术前和术后1、3、5、7、9d血清C反应蛋白(CRP)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)含量变化,观察术后全身炎症反应综合征(SIRS)及多器官功能不全综合征(MODS)的发生率,以及其他各种并发症发生率。结果EN组术后第3、5、7、9天的CRP、IL-6、TNF-α血清水平较PN组和对照组下降显著(P<0.05),PN组与对照组比较无显著性差异;EN组SIRS持续时间(3.26±1.27)d明显短于PN组的(5.31±1.47)d和对照组的(5.69±1.58)d(P<0.05);EN组MODS发病率为9.52%,明显低于PN组(23.81%)和对照组(27.78%)(P<0.05);EN组术后并发症发生率为19.0%,明显低于PN组(38.1%)和对照组(55.6%)(P<0.05),而PN组又低于对照组(P<0.05);在感染性并发症方面,EN组明显低于PN组和对照组(P<0.05)。结论梗阻性黄疸术后早期肠内营养能有效地减轻SIRS,降低MODS发病率,减少术后并发症的发生,促进患者康复。

Objective To observe the effects of early enteral nutrition（EN] on system inflammatory response syndrome（SIRS） after the operations for obstructive jaundice. Methods According to random table, 60 cases of postoperative patients with obstructive jauncdice were divided into three groups accepting early enteral nutrition, parenteral nutrition or general IV infusion respectively. CRP, IL-6 and TNF- α were measured on the day before operation and on the postoperative day 1, 3, 5, 7and 9. At the same time, the clinical conditions of patients with SIRS, MODS and postoperative complications were observed and analyzed. Results Patients in all groups had SIRS after operations. The levels of CRP, IL-6 and TNF- α on the day 3,5,7,9 after operations were lower in the EN group than those in the PN group and control group. The duration of SIRS in the EN group was significantly shorter than that in the PN group and control group. The morbidity of MODS and postoperative complications was lower significantly in the EN group than that in the PN group and contral group. Conclusions Early EN after operations on the patients with obstructive jaundice can positively modulate SIRS and decrease the morbidity of MODS and postoperative complications.