肝硬化脾切加门奇断流术序贯肠内营养支持干预护理观察

Nursing Observation on Sequential Enteral Nutrition Support Intervention for Liver Cirrhosis

目的探讨肝硬化合并门静脉高压及脾亢脾切加门奇断流术患者围术期序贯营养支持干预护理观察结果。方法选择行脾切除加门奇断流术肝硬化合并门静脉高压及脾亢患者50例,随机分为观察组(n=26)和对照组(n=24)两组。对照组围术期给予全肠外营养(TPN),观察组在TPN基础上实施序贯肠内营养支持(ESEN)。对比术前和术后1周、术后第3和6个月两组体质指数(BMI)及营养评定生化指标,术后恢复和生活质量情况。结果术前1周,两组BMI及营养评定生化指标对比差异无统计学意义(P> 0.05)。术后1周,两组血清总蛋白(TP)、清蛋白(ALb)比较差异无统计学意义(P> 0.05),观察组BMI、前清蛋白(PA)水平及淋巴细胞总数(Lc)明显高于对照组(P<0.05)。出院后第3、6个月,观察组BMI、TP、ALb、PA、Lc水平均显著高于对照组(P <0.001);观察组术后平均住院时间明显短于对照组;出院后6个月生活质量比较,观察组躯体健康状态和功能领域平均得分明显高于对照组,症状领域得分明显低于对照组;以上差异均有统计学意义(P <0.05)。结论对肝硬化合并门静脉高压及脾亢脾切加门奇断流术患者围术期给予ESEN干预,可显著改善患者营养状况,促进术后恢复,提高生活质量。

Objective To investigate the results of perioperative nursing intervention of perioperative nutritional support intervention for patients with liver cirrhosis complicated with portal hypertension and spleno-phage-sparing portal-arthritis. Methods 50 patients with hepatic cirrhosis combined with portal hypertension and splenomegaly were selected for splenectomy and combined with portal vein dementia. They were randomly divided into observation group （n=26） and control group （n=24）. The control group was given total parenteral nutrition （TPN） during the perioperative period, and the observation group performed sequential enteral nutrition support （ESEN） on the basis of TPN. The preoperative and postoperative 1 week, postoperative 3rd and 6th months the two groups of BMI （BMI） and nutritional assessment biochemical indicators, postoperative recovery and quality of life. Results One week before surgery, there was no signifcant difference in BMI and nutritional assessment biochemical indicators between the two groups （P 〉 0.05）. At 1 week postoperatively, serum total protein （TP） and albumin （ALb） had no signifcant diference between the two groups （P 〉 0.05）. BMI, prealbumin （PA） and lymphocyte count （Lc） were signifcantly higher in the observation group than in the two groups. Control group （P 〈 0.05）. At the 3rd and 6th month after discharge, the BMI, TP, ALb, PA, and Lc levels in the observation group were signifcantly higher than those in the control group （P 〈 0.001）; The average hospital stay in the observation group was significantly shorter than that in the control group; 6 after discharge Compared with the monthly quality of life, the average scores of physical health and functional areas in the observationgroup were significantly higher than those in the control group, and the scores in the symptom areas were significantly lower than those in the control group; the above diferences were statistically signifcant （P 〈 0.05）. Conclusion ESEN intervention in perioperative patients with liver cirrhosis combined with portal hypertension and splenomegaly and splenotomy and cut-of and gated decompression can signifcantly improve the nutritional status of patients, promote postoperative recovery, and improve quality of life.