持续与间断肠内营养对创伤性肠破裂患者术后喂养不耐受的比较研究

A Comparative Study of Continuous and Intermittent Enteral Nutrition on Postoperative Feeding Intolerance in Patients with Traumatic Intestinal Rupture

目的比较持续与间断肠内营养方式对创伤性肠破裂患者行腹腔镜术后发生喂养不耐受(FI)的影响。方法收集2017年12月~2019年12月因收治于我院的TIR患者,所有患者均行腹腔镜肠修补术。根据术后肠内营养方式不同分为间断组和持续组。最终78例患者纳入本项研究,其中EN间断组43例,持续组35例。收集患者年龄、性别、体重指数(BMI)、FI发生率等一般资料。比较两组入院时,治疗后1、7天的血清转铁蛋白(TF)、前清蛋白(PA)、白蛋白(ALB)、T淋巴细胞功能亚群比例(CD3+、CD4+、CD8+)及并发症发生情况。结果间断组FI发生率为16.28%,低于持续组的57.14%,差异有统计学意义(P<0.05);两组EN治疗后7天,间断组营养指标TF、PA、ALB血清浓度及免疫指标CD3+、CD4+、CD8+和CD4+/CD8+高于持续组,差异有统计学意义(P<0.05);输注相关并发症间断组发生率为23.3%,低于持续组的53.5%,差异具有统计学意义(P<0.05)。结论早期间断EN支持治疗更有利于降低TIR患者FI发生,改善患者营养状况和细胞免疫功能,并能降低输注相关并发症发生,促进TIR术后康复。

Objective To compare the effects of continuous and intermittent enteral nutrition on feeding intolerance(FI)in patients with traumatic intestinal rupture after laparoscopic surgery.Methods Collecting TIR patients admitted to our hospital from December 2017 to December 2019.All patients underwent laparoscopic bowel repair.According to different postoperative enteral nutrition methods,they were divided into discontinuous group and continuous group.Finally,78 patients were included in this study,including 43 in the EN discontinuous group and 35 in the continuous group.Collect general data such as age,gender,body mass index(BMI),and incidence of FI.To compare the ratios of serum transferrin(TF),prealbumin(PA),albumin(ALB),T lymphocyte function subgroups(CD3+,CD4+,CD8+)and complications of the two groups on admission,1 and 7 days after treatment symptoms occurred.Results The incidence of FI in the intermittent group was 16.28%,which was lower than 57.14%in the continuous group,the difference was statistically significant(P<0.05);7 days after EN treatment in the two groups,the serum concentrations of nutritional indicators TF,PA,ALB and immune indicators in the intermittent group CD3+,CD4+,CD8+and CD4+/CD8+were higher than the continuous group,the difference was statistically significant(P<0.05);the incidence of intermittent infusion-related complications was 23.3%,which was lower than 53.5%of the continuous group,the difference was statistically significant(P<0.05).Conclusion Early intermittent EN supportive treatment is more beneficial to reduce the incidence of FI in patients with TIR,improve the nutritional status and cellular immune function of patients,and can reduce the incidence of infusion-related complications and promote postoperative recovery of TIR.