肠内与肠外营养支持在胰十二指肠切除术后应用的前瞻性研究

Prospective study of enteral nutrition and parenteral nutrition in post-pancreaticoduodenectomy patients

目的:探讨肠内营养(enteral nutrition,EN)和肠外营养(parenteral nutrition,PN)支持在胰十二指肠切除术(pancreaticoduodenectomy,PD)后的临床应用价值。方法:将84例PD患者随机分为两组:EN组(42例)术中置入鼻肠管,术后24 h开始EN;PN组(42例)术后24 h给予PN。两组采用等热量、等氮量方案,比较两组患者的术后并发症、营养相关并发症、营养状况、肝功能指标、术后住院时间和费用。结果:PD后EN和PN均能改善患者的营养状态。EN组与PN组相比:总并发症发生率分别14.3%(6/42)与33.3%(14/42),组间比较存在显著性差异(χ2=4.200,P=0.040);经口进食时间分别为术后(44.5±7.1)h与(76.1±12.3)h、住院期间费用分别为(51 358±5 114)元与(64 650±11 977)元,两组间比较均存在显著性差异[(t=14.375,P=0.017);(t=6.614,P=0.003)]。术后第7天肝功能指标(γ-GT、ALT、AST及TBiL)EN组均明显好于PN组,均存在显著性差异。而两组患者病死率、术后胰瘘、胆漏、出血、胃排空障碍等并发症、术后住院时间、营养相关并发症以及术后第7天营养指标无显著性差异。结论:PD后早期肠内营养可以有效改善患者的肝功能,减低术后并发症的发生率,提早术后经口进食时间,降低住院期间费用,早期肠内营养在PD后的营养支持值得推荐。

Objective：To determine the effects of parenteral nutrition （PN） and enteral nutrition （EN） on biochemical and clinical outcomes in patients who underwent pancreaticoduodenectomy. Methods：Eighty-four patients who underwent pancreaticoduodenectomy were enrolled in this study. They were randomly divided into the EN group and the PN group. The program of isonitrogenous and isocaloric intake was taken in each group. The biochemical and clinical parameters were recorded and analyzed between the two groups. Results：Significant differences were found in total complications,initiation of soft diet,hospital cost and liver function on the 7th postoperative day （P 〈 0.05）. The incidence rate of complications was higher in PN group（33. 3%） than PD group（14.3%）（X2 = 4.200,P = 0.040） ;The hospital cost was higher and initiation of soft diet was later in PN group than in PD goup [ （64 650 ± 11 977） Yuan vs. （51 358 ±5114）Yuan,t = 6.614,P = 0.003;（76.1 ±12.3）h vs. （44.5 ± 7.1）h,t = 14.375,P = 0.017]. And liver function was much better in EN group than in PN group. No significant differences were found in mortality, anastomotic leakage, hemorrhage, delayed gastric emptying, nutritional status and postoperative hospital stay between EN group and PN group. Conclusion： EN support can improve the liver function,reduce the complications and hospital cost,and help soft diet initiation of patients undergoing pancreatoduodeneetomy. EN should be recommended as a regular treatment for patients who received pancreaticoduodenectomy.