肠外营养在肝硬化门静脉高压断流术后的应用研究

Parenteral nutritional support in patients with cirrhotic portal hypertention after pericardial devascularization

目的探讨肠外营养(PN)在肝硬化门静脉高压断流术后应用的安全性和有效性。方法选择符合标准的肝硬化门静脉高压断流术患者55例,随机分为实验组和对照组,实验组按照欧洲营养学会标准以结构脂肪乳、氨基酸、葡萄糖、维生素及微量元素配成"三升袋"从术后第1天至第7天行肠外营养;对照组术后给予和营养组等量氨基酸、葡萄糖、维生素及微量元素。检测2组术前及术后第1、3、5、7天肝功能、脂质代谢、免疫指标、机体测定及术后并发症。结果术后第7天,实验组肝功能指标谷丙转氨酶下降较对照组快(P<0.05);实验组体质量、上臂围、血浆前白蛋白、视黄醇结合蛋白及免疫指标上升较对照组快(P<0.05);2组术后胃肠道功能恢复时间比较差异有统计学意义(P<0.05)。2组甘油三酯、术后并发症差异无统计学意义。结论肝硬化门静脉高压断流术患者术后行肠外营养支持是安全和有效的,能够促进肝功能恢复,提高机体免疫力,改善营养状况,有利于患者早期恢复。

Objective To observe the security and availability of parenteral nutritional （PN） support in patients with cirrhotic portal hypertention after pericardial devascularization. Methods Fifty-five cases after pericardial devasculariza- tion were randomly assigned into 2 groups： PN group receiving PN support with structured triglyceride, amino acid, glu- cose, vitamin, microelement in regular ＂3 liter bag＂, and control group receiving regular fluid supplement, with the same amino acid, glucose, vitamin, microelement as PN group. Check postoperative liver function, lipid metabolism, immune function, body composition and complications on the preoperative and the 1 st, 3rd, 5th, 7th postoperative days. Results Compared with the control group, alanine aminotransferase of PN group dropped faster in the seventh day after the operation （ P 〈 0.05 ）. The body mass, upper-arm circumference, prealbumin, retinol binding protein, immunity target of PN group rose faster than the control group （ P 〈 0.05 ）. There was significant difference between the two groups in the recovery time of gastrointestinal tract （P 〈 0.05）. There were no significant differences between the two groups in triglyceride and com- plications （P 〉 0.05 ）. Conclusions PN is well tolerated, safe and available, which can accelerate the liver function, improve the immunity and nutrition of the body.