肠内外联合营养支持在恶性梗阻性黄疸姑息治疗中的应用

Application of combined nutrition support in alleviative treatment of malignant obstructive jaundice

目的探讨恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)姑息治疗中肠内外联合营养支持的优越性及其安全性。方法 65例MOJ患者在接受不同方式的姑息性胆道引流术后接受7 d营养支持,根据营养支持方式的不同分为肠外组(PN组,33例)和肠内外联合组(PN/EN组,32例),检测患者肝功能、免疫功能、营养水平及血脂水平的变化。结果全部患者胆道梗阻解除后均能耐受营养支持,PN/EN组患者较PN组谷丙转氨酶、总胆红素水平明显下降,胆碱酯酶水平上升,营养指标好转,血脂代谢改善,细胞免疫和体液免疫功能提高。结论 MOJ患者在解除胆道梗阻后,实行肠内外联合营养支持是一种安全的营养支持手段,能更加快速有效地改善营养状况、提高免疫力、减少肝功能的负担及血脂的堆积,因此具有更高的耐受性和安全性。

Objective To investigate the superiority and reliability of application of combined nutrition support in alleviative treatment of malignant obstructive jaundice （MOJ）. Methods Sixty-five patients with MOJ received seven-day nutritional support after alleviative biliary drainage, 33 patients were randomly assigned to receive parenteral nutrition （PN group, n=33）, and 32 patients were randomly assigned to receive parenteral nutrition combined with enteral nutrition （PN/EN group, n=32）. The changes of liver function, blood lipid, nutrition and immunity were observed. Results All patients after treatment were able to tolerate parenteral nutrition support. In PN/EN group, nutritional index of patients were improved, the levels of liver enzymes, bilirubin were decreased obviously, the levels of cholinesterase were increased, humoral and cellular immunity indicators were improved, and blood lipid metabolism tended to normal range. Conclusion Combined nutrition support is safer and more effective in improving malnutrition, abnormal liver function, immunodepression, and abnormal lipid metaholism after alleviative biliary drainage than oarenteral nutrition.