早期肠内营养对上消化道溃疡穿孔患者术后营养状态及临床预后的影响

Effect of Early Enteral Nutrition on Postoperative Nutritional Status and Clinical Outcomes of Patients with Upper Digestive Tract Ulcer Perforation after Operation

目的探讨早期肠内营养对上消化道溃疡穿孔患者术后营养状态及临床预后的影响。方法选取2012~2014年在菏泽市立医院胃肠外科急诊手术治疗的72例上消化道溃疡穿孔患者为研究对象,根据其进行的营养方式的不同分为术后早期肠内营养组（EEN组,36例）和术后按传统治疗方案给予全肠外营养组（TPN组,36例）,统计分析2组患者术前及术后第7天体质量、体质量指数以及前白蛋白和白蛋白水平,并记录术后首次肛门排气时间、术后住院时间、住院总费用及术后并发症发生情况。结果术前2组患者的体质量、体质量指数以及前白蛋白和白蛋白水平差异均无统计学意义（P〉0.05）,术后第7天上述各指标2组均明显下降,且TPN组下降程度大于EEN组,其差异有统计学意义（P〈0.05）。EEN组患者术后感染性并发症明显少于TPN组,术后首次肛门排气时间短于TPN组,住院时间和住院总费用短于或低于TPN组,其差异均有统计学意义（P〈0.05）。结论早期肠内营养可改善上消化道溃疡穿孔患者的营养状态,减少感染性并发症的发生,促进胃肠道功能早期恢复,降低了住院费用,加速了患者的康复。

Objective To investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. Methods Seventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition （EEN） group （n=36） and parenteral nutrition （TPN）group （n=36） according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. Results There were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups （P〉0.05）. On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group （P〈0.05）. The inflect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups （P〈0.05）. Conclusions Early postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.