胰十二指肠手术患者早期肠内营养支持耐受性及相关因素分析

Tolerance of early enteral nutrition support and its related factors in pancreatoduodenectomy patients

目的探讨胰十二指肠手术(PD)患者早期肠内营养(EN)支持耐受性及相关因素。方法选取107例PD手术患者为研究对象,根据术后EN耐受情况,将患者分为耐受组和不耐受组。采用单因素和多因素logistic回归分析PD术后患者EN不耐受的影响因素。结果107例PD术后患者,EN不耐受40例(37.38%),耐受67例(62.62%)。耐受组和不耐受组在年龄、术后随机血糖、术前总胆红素、胰管直径、术后低蛋白血症比较,差异均有统计学意义(χ^(2)分别=5.50、10.43、33.75、27.01、7.97,P均<0.05)。logistic回归分析结果显示,术后随机血糖≥11 mmol/L、术前总胆红素≥300μmol/L、胰管直径<3 mm、术后低蛋白血症是影响PD术后患者EN不耐受的危险因素(OR分别=1.35、3.46、2.15、1.86,P均<0.05)。结论PD术后患者EN耐受性较差,影响PD术后患者EN不耐受的危险因素有术后随机血糖≥11 mmol/L、术前总胆红素≥300μmol/L、胰管直径<3 mm、术后低蛋白血症。

Objective To explore the tolerance of early enteral nutrition(EN)support and its related factors in pa⁃tients undergoing pancreatoduodenectomy(PD).Methods A total of 107 patients undergoing PD were enrolled as the research objects.According to postoperative EN tolerance,they were divided into tolerance group and non-tolerance group.The influencing factors of EN non-tolerance after PD were analyzed by univariate and multivariate logistic regression analysis.Results In the 107 patients after PD,there were 40(37.38%)cases with EN non-tolerance and 67(62.62%)cases with tolerance.There were significant differences in age,postoperative random blood glucose,preoperative total bili⁃rubin,pancreatic duct diameter and postoperative hypoalbuminemia(χ^(2)=5.50,10.43,33.75,27.01,7.97,P<0.05).The re⁃sults of logistic regression analysis showed that postoperative random blood glucose≥11 mmol/L,preoperative total biliru⁃bin≥300μmol/L,pancreatic duct diameter<3 mm and postoperative hypoalbuminemia were risk factors of EN non-tol⁃erance after PD(OR=1.35,3.46,2.15,1.86,P<0.05).Conclusion There is poor EN tolerance in patients after PD.The independent risk factors of EN non-tolerance include postoperative random blood glucose≥11 mmol/L,preoperative total bilirubin≥300μmol/L,pancreatic duct diameter<3 mm and postoperative hypoalbuminemia.