老年患者消化道术后肠外营养相关性肝损伤及影响因素回顾性分析

Retrospective Analysis of Influencing Factors of Parenteral Nutrition-associated Liver Disease in Elderly Patients after Gastrointestinal Surgery

目的探讨老年患者消化道术后肠外营养相关性肝损害(parenteral nutrition-associated liver disease,PNALD)的发生情况及其影响因素。方法回顾性分析162例接受全肠外营养支持的住院患者资料,包括年龄,性别,身高,体质量,体质量指数,消化道手术类型(食管、胃、结直肠等),禁食时间,肠外营养(PN)应用时间,总热量,非蛋白热量,热氮比,糖脂比,脂肪乳,氨基酸和葡萄糖用量,肝功能,PN时患者感染情况等。结果162例患者中,发生PNALD 37例(22.8%);PNALD组禁食时间,PN支持时间较肝功能正常组延长(P<0.05);PNALD组感染率较正常组升高(P<0.05)。结论老年患者消化道手术后PNALD发生率为22.8%。老年患者围术期缩短禁食时间和PN使用天数,控制感染,可降低PNALD发生率。

Objective To explore the prevalence of parenteral nutrition-associated liver disease(PNALD)and its influencing factors after gastrointestinal surgery in elderly patients.Methods 162 patients received total parenteral nutrition after gastrointestinal surgery were retrospectively analyzed.Age,sex,height,bodyweight,body mass index,type of digestive tract operation(esophagus,stomach,colorectal,etc.),the fasting time,the duration of parenteral nutrition(PN)support,total calorie,nonprotein calorie,non-protein energy to nitrogen ratio,ratio of glucose to lipid,fat emulsion,amino acid consumption,glucose consumption,liver function and the infection condition during PN were collected.Results The prevalence of PNALD was 22.8%(37/162).The fasting time,the duration of PN in PNALD group were obviously longer than that in normal liver funtion group(P<0.05).The infection rate of PNALD group was higher than that of normal group(P<0.05).Conclusion The incidence of PNALD in elderly patients after gastrointestinal operation was 22.8%.Shortening the fasting time and the duration of PN support,prevention of infection can reduce the incidence of PNALD.