肝移植术后早期肠内营养的临床疗效观察

Efficacy of early enteral nutrition support in patients following liver transplantation

目的:探讨肝移植术后患者早期肠内营养(EN)支持的疗效。方法:55例肝移植患者分别在术后48 h内给予EN(27例,EN组)或肠外营养(28例,PN组)支持。比较两组术后第1、9天血清白蛋白(ALB)、前白蛋白(PA)、淋巴细胞计数(LC)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)等指标,及术后2周内感染发生情况、机械通气时间、ICU住院天数、术后住院天数。结果:两组术后第1天各实验室指标差异无统计学意义(均P>0.05),术后第9天,EN组ALB、PA、LC水平均明显高于PN组(均P<0.05);两组间ALT、AST、TBIL、DBIL水平差异无统计学意义(均P>0.05),但均较术后第1天明显下降。EN组术后2周内感染发生率明显低于PN组(P<0.05)。两组机械通气时间和ICU住院时间差异无统计学意义(均P>0.05),但EN组术后住院时间明显低于PN组(P<0.05)。结论:肝移植术后患者早期应用EN支持,可以有效改善机体营养状态和免疫功能,减少感染发生率,促进术后康复。

Objective： To investigate the efficacy of early enteral nutrition （EN） in patients after liver transplantation. Methods： Fifty-five patients were given EN （27 cases, EN group） or parenteral nutrition （28 cases, PN group） support within 48 h after liver transplantation. The laboraotory parameters that included albumin （ALB）, prealbumin （PA）, lymphocyte count （LC）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBIL）, and direct bilirubin （DBIL） on postoperative day （POD） 1 and 9, the infection rate during 2 weeks after transplantation, mechanical ventilation time, and length of ICU and postoperative hospital stay between the two groups were compared. Results： The differences in all the laboratory parametes between the two groups showed no statistical significanceon POD 1 （all P〉0.05）, while on POD 9, the levels ofALB, PA and LC in EN group were significantly higher than those in PN group （all P〈0.05）, and the levels ofALT, AST, TBIL and DBIL between the two groups showed no statistical difference （all P〉0.05）, but were all decreased compared with their values on POD 1. The incidence of infection within 2 weeks post-transplantation in EN group was significantly lower than that in PN group （P〈0.05）. The mechanical ventilation time and length of ICU stay between the two groups had no statistical difference （both P〉0.05）, but the length of postoperative hospital stay in EN group was significantly reduced compared with PN group （P〈0.0S）. Condusion＂ In patients undergoing liver transplantation, early application of EN support can effectively improve their nutritional status and immune function, as well as reduce the chance of infection and promote postoperative recovery.