围术期肠内营养乳剂支持对贲门周围血管离断术后肝功能与应激反应的影响

Effect of enteral nutrition emulsion on liver function and stress response after splenectomy

目的探讨围术期肠内营养乳剂支持对肝硬化门脉高压(门脉高压症)患者脾切贲门周围血管离断术(断流术)后肝功能与应激反应的影响。方法前瞻性纳入2016-01—2019-06间在河南中医药大学第一附属医院普外腔镜微创外科行断流术的56例门脉高压症患者,依据围术期肠内营养支持方法分为营养乳剂组(治疗组)与常规营养组(对照组),各28例。比较2组患者的基线资料,术前1天和术后第8天的血清总胆红素(TBIL)、白蛋白(ALB)、凝血酶原时间(PT)肝功能指标和C反应蛋白(CRP)应激反应指标。结果术前1天,2组患者的肝功能和应激反应指标差异无统计学意义(P>0.05)。术后第8天,治疗组的TBIL、ALB水平均好转并优于对照组,差异有统计学意义(P<0.05);C反应蛋白(CRP)、凝血酶原时间(PT)显著低于对照组,差异有统计学意义(P<0.05)。结论围术期肠内营养乳剂支持能明显改善门脉高压症断流术后患者的肝功能,并有效减轻应激反应。但仍需大样本前瞻性随机对照研究予以证实。

Objective To investigate the effect of enteral nutrition support on liver function and perioperative stress response in patients with cirrhosis and portal hypertension after splenectomy.Methods From January 2016 to June 2019,56 patients with cirrhosis and portal hypertension underwent surgical treatment in our department were randomly divided into treatment group(Enteral nutrition emulsion)and control group(General diet),28 cases in each group.The treatment group was given enteral nutrition emulsion by oral administration or nasogastric tube for 3 days before operation according to the energy requirement of 30kcal/(kg·d),while the control group received routine diet.The treatment group received 25%and 50%of the physiological requirement on the 1st and 2nd day after operation,100%of the physiological requirement on the 3rd and 7th days after operation,and the diet changed from liquid food to normal diet from the 3rd day.The control group received general diet and routine parenteral nutrition support treatment,according to calories of 30kcal/(kg·d)calculation,1-3days after the gradual transition to normal diet.The changes of liver function and related indexes of stress response were compared between the two groups during perioperative period.Results There was no significant difference in liver function and stress response between the two groups one day before operation.On the 8th day after operation,total bilirubin(TBIL)and albumin(ALB)in the experimental group were improved and significantly higher than those of the control group(P<0.05).PT and CRP were significantly lower than those of the control group(P<0.05).Conclusion Perioperative enteral nutrition support can significantly improve liver function and alleviate stress response in patients with cirrhosis and portal hypertension after splenectomy.