早期肠内营养治疗在A型主动脉夹层术后伴乳糜胸中的疗效分析

The effect of early enteral nutrition therapy in the patients with chylothorax after type A aortic dissection

目的:分析早期肠内营养(EEN)治疗中,低脂低渗型肠内营养(EN)制剂对A型主动脉夹层术后伴乳糜胸的应用效果。方法:选取本院诊治的90例A型主动脉夹层行孙氏手术后伴乳糜胸病人,应用低脂低渗型EN制剂进行营养治疗,根据营养治疗时机分为EEN组(n=45,术后48 h内进行EN)和对照组(n=45,早期全肠外营养和48 h后进行EN),收集和比较两组病人住院总天数、术后住院天数、24 h引流量、引流管拔管时间,术前1 d和术后7 d、14 d的实验室检查指标和营养风险(NRS 2002)评分等指标。结果:EEN组与对照组引流管拔管时间分别为(8.9±3.6)d和(12.4±4.5)d,术后住院天数分别为(20.2±5.3)d和(24.5±6.6)d,术后14 d的总蛋白(TP)分别为(63.3±6.5)g/L和(61.4±5.3)g/L,血清白蛋白(ALB)分别为(38.6±4.9)g/L和(36.2±4.2)g/L,淋巴细胞(LYMPH)分别为(2.4±0.6)109/L和(2.1±0.4)109/L,差异有统计学意义(均P<0.05)。结论:低脂低渗型EN制剂有效减少乳糜产生,EEN可缩短引流管拔管时间、术后住院天数,改善病人营养状况。

Objective:To evaluate the efficacy of early enteral nutrition(EEN)therapy in the patients with chylothorax after type A aortic dissection.Methods:Ninety type A aortic dissection patients treated by Sun’s procedure were randomly divided into EEN group(n=45,EN within 48 hours after surgery)and the control group(n=45,total parenteral nutrition and EN after 48 hours),according to the timing of nutrition treatment.The length of hospital stay,postoperative hospital stay,24 h flow and drainage tube removal time,laboratory examination indexes and nutritional risk(NRS 2002)score 1 d before operation and.7 d and 14 d after operation were analyzed and compared.Results:The drainage tube removal time[(8.9±3.6)d vs(12.4±4.5)d],length of postoperative hospital stay[(20.2±5.3)d vs(24.5±6.6)d]of the EEN group were significantly shorter than that of the control group.Total protein(TP)[(63.3±6.5)g/L vs(61.4±5.3)g/L],serum albumin(ALB)[(38.6±4.9)g/L vs(36.2±4.2)g/L]and Lymphocytes(LYMPH cells)[(2.4±0.6)109/L vs(2.1±0.4)109/L]were improved in the EEN group on 14 d after operation.Conclusion:EEN therapy with low fat and hypotonic formulation can reduce the rate of chylothorax.EEN can shorten the drainage tube removal extubation time,postoperative hospital stay and improve the nutritional status of patients.