早期肠内营养联合肠外营养用于梗阻性黄疸患者术后营养支持的临床价值

Clinical value of early enteral nutrition combined with parenteral nutrition in postoperative nutritional support for patients with obstructive jaundice

目的探讨梗阻性黄疸患者早期给予肠内、肠外联合营养支持对术后胃肠功能、营养状况以及肝功能的影响。方法2013年7月至2014年7月华北理工大学附属医院普通外科收治的实施手术的梗阻性黄疸患者62例，按随机数字表法分为观察组与对照组，每组各31例。对照组患者给予单纯肠外营养，术后第1天经中心静脉导管输注，时间为12—15h，连续输注7d以上。观察组患者给予肠内营养联合肠外营养，术后先给予肠外营养，营养液的配制及方法与对照组一致；第2天对空肠营养管缓慢滴人生理盐水250ml；第3天滴入肠内营养液，初始剂量每日300—500ml，以20～30ml／h的速度缓慢滴入。结果观察组患者术后首次排气时间[（41．37±6．85）h]、首次排便时间[（46．85±7．13）h]、住院时间[（12．79±3．76）d]明显短于对照组[排气时间（57．21±9．23）h、首次排便时间（61．43±10．62）h、住院时间（16．94±4．33）d]（t值分别为7．67、6．35、4．03，P均〈0．05），每日住院费用（1637．65±138．24）元明显少于对照组[（2121．42±112．38）元]（t=15．12，P〈0．05）。对照组和观察组患者手术前血清白蛋白分别为（28．73±3．24）g／L和（29．21±3．31）g/L，治疗后分别为（36．85±4．05）g/L和（47．21±4．13）g/L；对照组和观察组患者手术前血清前白蛋白水平分别为（162．81±31．27）g／L和（163．14±30．56）g／L，治疗后分别为（248．95±58．62）g/L和（324．24±61．34）g／L。手术前两组血清蛋白水平比较差异均无统计学意义（P均〉0．05）；与对照组比较，治疗后观察组血清蛋白水平有明显升高（P均〈0．01）。手术前两组患者ALT、总胆红素和直接胆红素水平比较差异均无统计学意义（P均〉0．05），治疗后观察组患者ALT、总胆红素和直接胆红素水平较对照组改善明显（P均〈0．01）。两组患者治疗后均恢复良好，均未出现严重不良反应。结论早期进行肠内联合肠外营养支持治疗实施手术的梗阻性黄疸患者，具有较好的效果和安全性。

Objective To investigate the effect of early early enteral nutrition combined with parenteral nutrition support on postoperative gastrointestinal function, nutritional status and liver function of patients with obstructive jaundice. Methods Sixty-two patients with obstructive jaundice of hepatobiliary who were treated in the General Surgery Department of the Affiliated Hospital of North China University of Science and Technology from July 2013 to July 2014 were randomly divided into the control group and the observation group,31 cases in each group. The control group were treated with simple parenteral nutrition, and were injected by central venous catheter at the first day after operation,with the injection tiem of 12-15 h and continuous infusion of 7 d or more. The observation group were received enteral nutrition combined with parenteral nutrition, parenteral nutrition was given first, and the preparation method of the nutrient solution was identical with that of the control group;and then slowly dropped 250 ml physiological saline into the jejunum nutrition tube at the second day, dropped into the enteral nutrition liquid at the third day with the initial dose of 300 to 500 ml per day, slowly dropped in the speed of 20-30 ml/h. Results The first exhaust time, first defecation time and hospitalization time in the observation group were （41.37±6. 85）h, （46. 85±7. 13）h and （ 12. 79±3. 76） d,significantly shorterthan those in the control group （ （ 57.21 ± 9. 23 ） h, （ 61.43 ± 10. 62 ） h and （ 16. 94± 4. 33 ） d; t = 7. 67,6. 35, 4.03 ;P〈0. 05）, daily hospitalization expenses was （1637.65± 138.24）yuan, significantly less than that in the control group（ （2121.42±112. 38）yuan;t= 15.12;P〈0.05）. The serum albumin berofe and after the operation in the control group and observation group were （28.73±3.24） g/L and （29. 21±3. 31） g/L, （36. 85±4. 05） g/L and （47. 21±4. 13） g/L, respectively. The serum pre albumin berofe and after the operation in the control group and observation group were （ 162. 81±31.27） g/L and （ 163.14±30. 56） g/L, （248. 95±58. 62） g/L and （324. 24± 61.34） g/L, respectively. There was no difference before operation between the two groups （P 〉0. 05） ,while the serum protein levels were significantly increased in observation group than the control group （P〈0.01）. There were no difference in ALT ,total bilirubin and direct bilirubin levels between the two groups before operation （P 〉 0. 05 ）, after treatment, the levels of ALT, total bilirubin and direct bilirubin in the observation group were significantly higher than those in the control group（ P〈0. 01 ）. The patients in the two groups recovered well, and no serious adverse reactions occurred. Conclusion Early enteral and parenteral nutrition support in patients with obstructive jaundice has better effect and safety in the clinical treatment.