早期肠内营养对胰十二指肠切除术后发生感染的影响分析

Impact of early enteral nutrition on infections after pancreaticoduodenectomy

目的探讨早期应用肠内营养对胰十二指肠切除术后发生感染的影响效果,以降低术后感染的发生,改善患者预后。方法选取2008年8月-2012年8月行胰十二指肠切除术患者52例,其中术后行肠内营养组与行肠外营养组各26例,肠内营养组术后第1天应用葡萄糖注射液,第2天开始应用肠内营养液,并逐渐增加营养液的量;肠外营养组术中即行颈内静脉穿刺置管,术后1d开始利用静脉营养混合液进行肠外营养支持,直至患者恢复口腔进食;分别于术后第1、3、8天检测患者肝功能情况,术后第1、8天检测患者血中内毒素及(1-3)-β-D葡聚糖浓度水平。结果术后第8天患者肝功能状况较术前明显恢复,组间比较差异无统计学意义;肠内营养组患者术后第8天与术前比较,血中内毒素和(1-3)-β-D葡聚糖浓度水平无明显变化,而肠外营养组患者此两者浓度术后第8天均明显高于术前(P<0.05);肠内营养组的腹腔内感染及腹腔外感染率分别为3.84%和7.69%明显低于肠外营养组的19.23%和46.15%(P<0.05),两组间发生肺部感染及切口感染的概率差异无统计学意义。结论胰十二指肠切除术后早期采用肠内营养能明显提高患者的全身营养状况,保持患者肠道的正常结构和生理功能,有效减少腹腔内外感染等并发症的发生,能明显改善患者预后,安全经济,值得临床推广。

OBJECTIVE To study the effect of early enteral nutrition on the infections after pancreaticoduodenectomy so as to reduce the incidence of postoperative infections and improve the prognosis. METHODS A total of 52 cases of patients who underwent the pancreaticoduodenectomy in the hospital from Aug 2008 to Aug 2012 were selected, among which there were 26 cases who were given the enteral nutrition and 26 cases who received the parenteral nutrition. In the enteral group, glucose injection was performed one day after the operation, and the enteral nutrition fluids was injected from the second day, and the amount was increased day by day. While the parenteral group was performed with the internal jugular vein intubation, and parenteral nutrition mixture was used for the nutrition support one day after the operation until oral feeding. The liver function was observed respectively on the first day, third day and eighth day after the surgery, and the levels of endotoxin and （1, 3）{ beta}-D-giucan were detected respectively on the first day and the eighth day after the surgery. RESULTS The liver function recovered significantly 8 days after the surgery as compared with that before the surgery, and there was no statistical difference between the two groups~ there was no significant change in the concentration of endotoxin or the （1, 3） {beta}-D-glucan in the enteral group 8 days after the operation, nor was before the surgery, however, in the parenteral group the concentrations of the two were significantly higher 8 days after the operation than before the operation （P 〈 0. 05）. In the enteral group the incidence rates of the intra-abdominal and outer-abdominal infections were respectively 3.84% and 7.69% ,significantly lower than 19.23% and 46. 15% of the parenteral group （P〈0.05）, and the difference in the incidence of pulmonary infections or the incision infections between the two groups was not statistically significant. CONCLUSION Taking early enteral nutrition after pancreaticoduodenectomy can improve the nutritional status, keep the structure and function of intestinal tract normal, effectively reduce the incidence of complications such ast he intra-abdominal and outer-abdominal infections, and significantly improve the prognosis, it is safe and economical and is worthy of clinical promotion.