肠内营养时机的选择对胰十二指肠切除患者术后恢复的影响

Effects of timing of enteral nutrition on clinical outcomes of patients with pancreatoduodenectomy

目的探讨肠内营养时机的选择对胰十二指肠切除患者术后免疫功能、肠功能恢复及并发症的影响。方法纳入2016年1月~2017年12月期间我院收治的120例行胰十二指肠切除术治疗的患者,并随机分为A、B和C组,每组40例;A组患者术后12h内开始肠内营养支持,B组患者24h内开始营养支持,C组患者48h后开始营养支持。记录并分析各组患者术后体重、ALB、PA、CD4+/CD8+、肠鸣音恢复时间、肛门排气时间、排便时间、进食时间、拔除鼻肠管时间及并发症发生率。结果术后10d时B组体重、ALB、PA及CD4+/CD8+的恢复状况显著好于A、C组(P<0.05);术后B组肠鸣音恢复时间、肛门排气时间、排便时间、进食时间及拔除鼻肠管时间显著低于A、C组(P<0.05);且B组术后总并发症发生率明显低于A、C组,差异均有统计学意义(P<0.05)。结论行胰十二指肠切除术治疗患者在术后24h内采用肠内营养干预可有效提高患者免疫功能及肠功能恢复时间,减少并发症,改善患者预后和生活质量。

Objective To investigate the effects of timing of enteral nutrition on immune function,intestinal function recovery and complications in patients undergoing pancreaticoduodenectomy.Methods 120 pancreatoduodenectomy patients from January 2016 to December 2017 in our hospital were randomly divided into group A(start nutrition support within 12h),group B(start nutrition support within 24 h)and group C(start nutrition support after 48h).The body weight,ALB,prealbumin,CD4+/CD8+,bowel sounds recovery time,anus exhaust time,defecation time,feeding time,extraction time of nasointestinal tube and postoperative complications in each group were analyzed.Results The body weight,ALB,prealbumin and CD4+/CD8+in group B were significantly higher than that of group A and group C(P<0.05).The bowel sounds recovery time,anus exhaust time,defecation time,feeding time and extraction time of nasointestinal tube in group were significantly lower than that of group A and group C(P<0.05).The postoperative complications in group B was significantly lower than that of group A and group C,and the difference was statistical significance(P<0.05).Conclusion The use of enteral nutrition in patients with 24h after pancreaticoduodenectomy can effectively improve the immune function and recovery time of intestinal function,and improve the quality of patients'prognosis.