肠内营养对肝功能受损病人术后肠粘膜屏障的影响

The effect of enteral nutrition on gut barrier in patients with hepatic dysfunction

目的 :探讨严重肝功能损伤的病人术后施行肠内营养 (EN)支持对胃肠道粘膜屏障的保护作用及临床意义。 方法 :将肝功能为ChildB级或C级的成年病人共 76例 ,随机分为肠内营养组 (EN ,n =30 )、全肠外营养组(TPN ,n =2 6)和对照组 (CON ,n =2 0 ) ,分别检测三组病人术前 1天、术后 5天和 1 0天时的营养状况及肝功能的变化 ,并检测尿中排泄的乳果糖 (L)和甘露醇 (M )的比值 (L/M ) ,观察不同营养方法对肠粘膜通透性的影响。 结果 :EN组和TPN组病人术后都无明显肝功能损害加重的表现 ;EN组病人术后较早达到正氮平衡 ,体重减轻较少 ,与TPN组相比差异显著 (P <0 .0 5) ;EN组病人手术前、后L/M值无明显变化 (P >0 .0 5) ,而TPN组和CON组变化明显 (P <0 ,0 5)。 结论 :对肝功能严重受损的病人 ,EN是一种方便、安全、有效的临床营养支持方法 ;

Objectives:To determine if enteral nutrition can protect the gut barrier in patients with damaged hepatic function and draw the clinical significance from it. Methods:76 patients whose hepatic function was in Child B or C grade were randomly assigned in enteral nutrition group(EN,30 cases),total parenteral nutrition group(TPN,26 cases) and control group(CON,20 cases).They were given with different nutritional support. Nutritional parameter and hepatic function indexes were massured at the day before operation,5th day and 10th day after the operation respectively.The concentrations of lactulose(L) and Mannitl(M) were detected in the urines with pulsed electrochemical detection(HPLC PED) and the L/M ratio was calculated. Results:No significant differences of hepatic function changes were observed between EN group and TPN group.It was the earlist that EN group reached the positive nitrogon equilibrium among the 3 groups and the loss of body weight after operation was the lowest in EN group There wes no change in L/M ratio in EN group, but the change was significant in TPN group( P <0.01) at the 5th day after the operation. Conclusions:EN is a rational,safe,effective and pratctical nutrition support method in the patients with hepatic dysfunction after operation and can protect the gut barrier from damage.