肠内结合肠外营养对腹腔镜下巨大消化性溃疡穿孔修补术后患者营养状况的影响

Influence of enteral combined with parenteral nutrition on nutritional condition of patients after laparoscopic repair of huge peptic ulcer perforation

目的:探讨肠内营养为主,结合肠外营养的营养方式对腹腔镜下巨大消化性溃疡穿孔修补术后患者营养状况的影响。方法:将80例行腹腔镜下巨大消化性溃疡穿孔修补术患者,采用随机数字法将其分为对照组和观察组各40例,对照组采用完全肠外营养,观察组采用肠内结合肠外营养方式;对比术后3 d、5 d和7 d营养学指标(血清白蛋白、前蛋白和转铁蛋白水平),免疫学指标(包括IgG定量、CD3+、CD4+和CD4+/CD8+),炎性指标(血清白细胞计数、IL-6、C反应蛋白、降钙素原水平)和临床指标(排气时间、大便潜血和切口感染阳性率)。结果:两组患者术后3 d、5 d和7 d血清白蛋白、前蛋白和转铁蛋白水平均随时间变化逐渐增加,且观察组均明显高于对照组,差异有统计学意义(P<0.05)。两组患者术后3 d、5 d和7 d血清IgG定量、CD3+、CD4+和CD4+/CD8+百分比均随时间变化逐渐增加,且观察组均明显高于对照组,差异有统计学意义(P<0.05)。两组患者术后3 d、5 d和7 d血清白细胞计数、IL-6、C反应蛋白、降钙素水平均随时间变化逐渐降低,且观察组均明显低于对照组,差异有统计学意义(P<0.05)。观察组较对照组排气时间明显缩短,大便潜血和切口感染阳性率明显降低,差异有统计学意义(P<0.05)。结论:以肠内营养为主,结合肠外营养的营养方式可改善腹腔镜下巨大消化性溃疡穿孔修补术后营养和免疫状况,减轻炎性水平,提高临床和护理质量。

Objective: To study the influence of enteral nutrition combined with parenteral nutrition on nutritional condition of patients after laparoscopic repair of huge peptic ulcer perforation. Methods: A total of 80 cases were enrolled and divided randomly into control and observation groups (each of 40 cases). The patients in control group received parenteral nutrition, while the patients in observation group adoped enteral nutrition combined with parenteral nutrition. Then we compared differences of nutrition index including serum albumin, prealbumin and transferrin levels after 3d, 5d and 7d, immunological index including IgG quantitation, CD3+, CD4+, and CD4+/CD8+ percentages, inflammatory index including white blood cell count, IL-6, C reactive protein and procalcitonin levels, the clinical indicators including mean time of exhaust and defecate, rates of fecal occult blood and incision infection. Results: The levels of serum albumin, prealbumin and transferrin in the two groups after 3d, 5d and 7d were gradually increasing, what’s more, those were all significantly higher in observation group(P<0.05).They were the same as immunological index, while the contrary to inflammatory index. The mean time of exhaust and defecate in observation group was significantly shorten, and rates of fecal occult blood and incision infection were both lower(P<0.05). Conclusion: It can greatly improve status of nutrition and immune in laparoscopic repair of huge peptic ulcer perforation, and reduce inflammatory response, which can bring better clinical and nursing values.