肝切除术后早期肠内肠外营养支持的前瞻性随机研究

Early postoperative enteral nutrition compared with parenteral nutrition after hepatectomy：A prospective randomized study

目的前瞻性研究早期肠内营养和肠外营养对肝部分切除术后病人的影响。方法78例肝部分切除手术病人随机分为2组。早期肠内营养（early enteral nutrition，EEN）组35例，肠外营养（parenteral nutrition，PN）组43例。两组病人均于术后24h开始给予等热量、等氮营养支持，共7d。观察术前、术后1d及术后8d病人一般情况、肝脏功能、临床营养、临床并发症等指标的变化。结果两组病人的平均住院时间以及手术前后肝功能、临床营养指标变化差异无统计学差异；EEN组术后8d前白蛋白已恢复到术前水平，虽然营养并发症发生率高于PN组，但程度较PN组轻。EEN组术后胃肠蠕动功能恢复较快，平均营养费用也明显低于PN组。结论肝部分切除术后进行早期肠内营养是安全、合理、有效的营养支持方式。早期肠内营养在改善肝功能，促进肝脏蛋白质合成代谢和胃肠蠕动功能恢复方面以及在减少临床营养费用方面优于肠外营养。

Objective To evaluate the impact of early enteral nutrition （EEN） compared with parenteral nutrition （PN） on patients after hepatectomy. Methods Seventy-eight patients undergoing liver resection were randomized prospectively into two groups： EEN group receiving early enteral nutrition （n=35） and PN group receiving parenteral nutrition （n=43）. The patients in both groups re- ceived isocaloric and isonitrogenous nutritional formulas 24 h after operation and the formulas were stopped on postoperative day 7. The general conditions, liver function tests, clinical complications, and clinical nutritional variables at three time points that included preoperative phase, postoperative day 1 （POD 1） and postoperative day 8 （POD 8） were observed. Results No significant differences were found in length of hospital stay, liver function and clinical nutritional variables between the 2 groups. In the EEN group, the serum prealbumin level almost returned to the preoperative level on POD 8. The nutritional complication rate of the EEN group was increased significantly but it was mil- der than that of the PN group. The time of gut function recovery in the EEN group was shorter than that of the PN group. The costs of nutritional drugs showed a significant decrease in the EEN group. Conclusion Early enteral nutrition is safe, rational and effective in patients who have undergone hepa tectomy. Early enteral nutrition is better than parenteral nutrition in promoting liver function recovery, liver protein synthesis, postoperative recovery of gut function and decreasing costs of nutritional drugs.