胃肠道术后早期行营养支持的方案对比

The comparison of different nutritional support programs after gastrointestinal surgery

目的比较胃肠道疾病患者手术治疗后早期行全肠内营养和肠外营养的疗效差异。方法回顾性分析2011年2月-2013年3月在陕西宝鸡市中医院普通外科接受手术治疗的胃肠道疾病患者的临床资料。入组患者根据营养支持方案分为全肠内营养支持组(TEN组)和全肠外营养组(TPN组)。比较两组患者的一般资料、营养状况、炎症指标、胃肠道功能恢复、肝功能改变、住院时间及费用等指标。结果本研究共纳入研究对象120例,其中TEN组63例,TPN组57例。术后第1天两组患者的炎性指标差异均无统计学意义(P>0.05)。术后第7天时,TEN组患者的BMI、Alb、TP、PA水平均显著高于TPN组(P<0.05);术后第7天时TEN组的CRP(t=2.805,P=0.006)和IL-6(t=2.464,P=0.015)水平显著低于TPN组;术后第7天时TPN组患者的ALT(t=2.073,P=0.04)和AST(t=5.187,P<0.01)水平均高于TEN组;TPN组患者的排气时间、排便时间、住院时间和住院费用均明显高于TEN组(P均<0.01)。结论早期肠内营养在改善患者机体营养状况、术后炎性指标下降速度、肝功能保护、胃肠道功能恢复、住院时间和住院费用方面均显著优于肠外营养。

Objective To compare therapeutic effects of total enteral nutrition and parenteral nutrition in patients with gastrointestinal diseases after surgery.Methods Clinical data of patients with gastrointestinal diseases received surgery treatment at Hospital of Baoji City in Shaan xi from Feb.2011 to Mar.2013 were retrospectively analyzed.The patients were divided into TEN group （total enteral nutrition group） and TPN group （total parenteral nutrition group） according to nutrition support scheme.The general information,nutritional status,inflammation,the recovery of gastrointestinal function,the liver function,hospitalization time,cost and other indexes between two groups were compared.Results A total of 120 patients were retrospectively analyzed,including 63 cases in TEN group and 57 cases in TPN group.The differences in inflammatory factors between two groups at the 1 st day after gastrointestinal surgery had no statistical significance （P ＞0.05）.The levels of BMI,Alb,TP,PA in TEN group were obviously higher than those in TPN group at the 7th day after gastrointestinal surgery （P ＜ 0.05）.The levels of CRP and IL-6 in TEN group were obviously lower than those in TPN group at the 7th day after gastrointestinal surgery.The levels of ALT and ANT in TPN group were obviously higher than those in TEN group at the 7th day after gastrointestinal surgery.The exhaust,defecate time,hospitalization time and cost of hospitalization in TPN group were obviously higher than those in TEN group at the 7th day after gastrointestinal surgery （P ＜ 0.01）.Conclusion The improvement of nutrition status,the decline rate of inflammatory markers,the protection of function of lung,the recovery of gastrointestinal function,the length of stay and hospital costs were significantly better in TEN group than those in TPN group.