腹部胃肠手术患者营养支持研究

Study on nutritional support for abdominal gastrointestinal operative patients

目的探讨腹部胃肠手术后营养支持对患者康复的影响。方法回顾性分析281例胃肠手术患者临床资料,其中术后营养支持组(营养组)患者157例,含胃肠内营养患者45例和静脉营养患者112例;对照组为术后未用营养支持的胃肠手术患者124例。比较两组患者体质量变化、血浆总蛋白含量、并发症发生率等指标。结果营养组患者术后精神状态评分[(3.3±0.5)分]显著优于对照组[(2.6±0.4)分],自由下床时间[(6.1±1.4)d]早于对照组[(12.6±2.1)d],体质量下降程度[(5.6±1.2)kg]显著小于对照组[(10.5±2.1)kg],术后出院时间短于对照组[分别为(15.6±1.3)、(19.8±1.5)d]。营养组患者血清总蛋白[(69.6±5.1)g/L]及清蛋白[(42.3±3.2)g/L]水平显著高于对照组[(58.3±5.5)、(35.4±3.1)g/L]。营养组伤口裂开发生比例、肠瘘发生率、伤口感染及肺部感染均少于对照组,两组均无明显不良反应发生。营养组胃肠内营养和静脉营养比较无显著区别。结论胃肠手术后进行营养支持有助于患者伤口愈合,减少并发症的发生。

Objective To explore the effect of postoperative nutritional support for the rehabilitation of the patients with abdominal gastrointestinal surgery.Methods The clinical data in 281 cases of gastrointestinal surgery were retrospectively analyzed.157 cases received the postoperative nutritional support as the nutrition group,including 45 cases of enteral nutrition and 112 cases of intravenous nutrition.Other 124 cases of gastrointestinal surgery without postoperative nutrition support were selected as the control group.The changes in body weight,plasma total protein content and complication incidence were compared between the two groups.Results The mental state score in the nutrition group was significantly higher that in the control group[（3.3±0.5） vs.（2.6±0.4）];the time of getting out of bed freely in the nutrition group was shorter than that in the control group[（6.1±1.4） vs.（12.6±2.1）d];the weight loss in the nutrition group was significantly less than that in the control group[（5.6±1.2） vs.（10.5±2.1）kg];the postoperative discharge time in the nutrition group was less than that in the control group;serum total proteinand and albumin in nutrition group were significantly higher than those in the control group[（69.6±5.1）、（42.3±3.2）vs.（58.3±5.5）、（35.4±3.1）g/L].The incidence rates of wound dehiscence,intestinal fistula,wound infection and lung infection in the nutrition group were less than those in the control group.All these data in the enteral nutrition group and parenteral nutrition group had not significant difference.Conclusion Nutritional support after gastrointestinal surgery helps patients to accelerate wound healing and reduce the occurrence of complications.