快速流程模式下肝切除患者围手术期不同营养支持的比较

Comparison of different perioperative nutritional support methods for hepatectomy patients under fast track scheme

目的:比较快速流程(FT)模式下肝切除患者围手术期不同营养支持方法的疗效。方法:将104例拟行肝切除患者随机均分为2组,分别接受肠内营养(EN)与肠外营养(PN组),所有患者均采用FT围手术期处理。比较两组患者手术前后体质量(WT)、血红蛋白(HB)、总蛋白(TP)、白蛋白(ALB)及总淋巴细胞计数(TLC)变化,以及术后肛门排气排便时间、住院天数、消化道不良反应和并发症发生率。结果:PN组术后7 d各项营养指标较术前3 d均明显降低,而EN组内只有TP及ALB较术前降低,但降幅均明显小于PN组(均P<0.05);EN组术后肛门排气排便时间较PN组明显提前,术后不良反应发生率低于PN组(均P<0.05);两组术后住院时间及并发症发生率差异无统计学意义(均P>0.05)。结论:FT模式下肝切除患者围手术期应用EN支持有利于改善营养状况及免疫功能,促进术后康复。

Objective： To compare different perioperative nutritional support methods for patients undergoing liver resection under fast track（FT） scheme.Methods： One hundred and four patients scheduled for liver resection were equally randomized into two groups to receive enteral nutrition support（EN group） and parenteral nutrition support（PN group）, respectively. All patients underwent FT perioperative management. Comparison was made between the two groups in pre- and postoperative changes in body weight（WT） and hemoglobin（HB）, total protein（TP）, albumin（ALB） and total lymphocyte count（TLC）, and postoperative time to first flatus and defecation, length of postoperative hospital stay, and incidence of gastrointestinal adverse reactions and postoperative complications.Results： The nutrition indicators on postoperative 7 d were all decreased significantly compared with preoperative 3 d values in PN group, among which only TP and ALB levels were signficantly decreased in EN group, but the decreasing amplitudes were signficantly less than those in PN group（all P0.05）. In EN group, compared to PN group, the time to either flatus or defecation was shortened, and the incidence of adversereactions was reduced（all 0.05）. There was no significant difference in length of postoperative hospital stay and incidence of postoperative complications between the two groups（all P0.05）.Conclusion： For hepatectomy patients receiving fast track protocol, perioperative EN support is beneficial for improving nutritional status and immune function, and accelerating postoperative recovery.