Whipple术后鼻空肠与空肠造口营养的临床效果

Clinical Effect of Enteral Nutrition Therapy Via Nasal-Jejunum Tube and Stoma of Jejunum after Whipple Procedure

目的比较Whipple术后经鼻空肠和空肠造口对肠内营养支持的影响。方法选取河北联合大学附属医院2008年1月至2013年5月期间实施的Whipple术患者87例,按不同的肠内营养方法分为经鼻空肠营养管组(47例)和空肠造口组(40例)。比较2组患者术后出现呕吐、腹胀、咽部疼痛等不良情况,术后出现坠积性肺炎情况及胰肠吻合口漏情况,住院时间,住院费用,术后第1、3、5 d血糖及血CL-、Na+、K+的浓度。结果空肠造口组患者呕吐、腹胀及咽部疼痛不良反应发生率和坠积性肺炎发生率均明显低于经鼻空肠营养管组(P<0.05),住院费用明显低于经鼻空肠营养管组(P<0.05)。2组胰肠吻合口漏发生率及住院时间比较差异均无统计学意义(P>0.05)。2组患者术后第1、3、5 d的血糖及血CL-、Na+、K+比较,差异亦均无统计学意义(P>0.05)。结论 Whipple术后经空肠造口行肠内营养,在减少术后出现呕吐、腹胀、咽部疼痛等不良情况和减少术后坠积性肺炎的发生方面与经鼻空肠行肠内营养比较有较好的临床效果,并在一定程度上减少住院费用,且住院时间、术后血糖及血电解质浓度无明显差异。

Objective To compare the clinical effects of enteral nutrition via stoma of jejunum or nasal-jejunum tube after Whipple procedure. Methods Eighty-seven patients performed Whipple procedure were divided into nasal- jejunum tube group （n=47） and stoma of jejunum group （n=40） according to the different enteral nutrition methods. The adverse reactions such as vomiting, abdominal distension, pharyngeal pain, and hypostatic pneumonia, anastomotie leakage, hospital stay, hospitalization expenses, and serum glucose and electrolyte （CL , Na＋, K~） on day 1, 3, 5 after operation were compared between two groups. Results Compared with the nasal-jejunum tube group, the rates of adverse reactions and hypostatic pneumonia were more lower （P〈0.05）, the hospitalization expense was more less （P 〈 0.05） in the nasal-jejunum tube group. The rate of anastomotic leakage and hospital stay had no significant differences between the nasal-jejunum tube group and stoma of jejunum group （P 〉 0. 05）. The differences of serum glucose and electrolyte （Cl-, Na＋, K＋） on day 1, 3, 5 after operation were not statistically significant between two groups （P〉0. 05）. Conclusions Enteral nutrition via the stoma of jejunum after Whipple procedure has some better clinical effects in reducing adverse reactions such as vomiting, abdominal distension, pharyngeal pain, hypostatic pneumonia. The hospitalization expenses are decreased. There are no obvious effects on the hospital stay, blood glucose and electrolyte concentration on day 1, 3, 5 after operation.