膳食纤维在超短肠综合征肠康复治疗中的作用研究

The role of dietary fiber in intestinal rehabilitation for patients with ultra-short bowel syndrome:a clinical study

目的探究膳食纤维在超短肠综合征肠康复治疗中的作用。方法研究纳入南京大学医学院附属医院普通外科2012年1月至2023年10月诊断为超短肠综合征的住院患者34例,根据其营养支持治疗期间是否行肠康复治疗分为三组:营养治疗组(11例)、生长激素+谷氨酰胺肠康复治疗组(10例)及生长激素+谷氨酰胺+膳食纤维肠康复治疗组(13例)。肠康复治疗组均采用重组人生长激素注射液0.05 mg/(kg·d),谷氨酰胺粉5 g/d。记录患者的治疗方案及其变化和治疗前后的血液学指标、营养指标、肠道吸收指标、粪便性状评分及生活质量评分等指标,分析不同治疗方案对患者临床结局的影响。结果与营养治疗组和生长激素+谷氨酰胺肠康复治疗组相比,生长激素+谷氨酰胺+膳食纤维肠康复治疗组的肠内营养液体增加量、肠外营养能量减少量、肠道湿吸收增加量、排便次数减少量及血红蛋白上升值等显著增加,差异有统计学意义(P<0.05);同时其治疗后胰岛素样生长因子-1及胰岛素样生长因子结合蛋白水平等营养状态相关指标明显升高(P<0.01)。结论营养支持联合肠康复治疗可以显著改善超短肠综合征患者营养状况及肠道吸收率等指标,在肠康复治疗方案中联合使用膳食纤维可使其获益更为显著。

Objective To investigate the role of dietary fiber in the intestinal rehabilitation for patients with ultra-short bowel syndrome.Methods This study included 34 inpatients diagnosed with ultra-short bowel syndrome in the General Surgery Department of the Eastern Theater General Hospital of the People's Liberation Army from January 2012 to October 2023.Patients were grouped based on whether they received intestinal rehabilitation and whether dietary fiber was added to the treatment plan,and were divided into three groups:nutritional therapy group(11 cases),growth hormone+glutamine intestinal rehabilitation treatment group(10 cases)and growth hormone injection+glutamine+dietary fiber intestinal rehabilitation treatment group(13 cases).The therapeutic regimen and its changes,pre-and post-treatment parameters of hematology,nutrition,intestinal absorption,fecal consistency,and quality of life were recorded and compared,and the impact of different treatment regimens on clinical outcomes was analyzed.Results Compared with nutrition treatment group and growth hormone+glutamine intestinal rehabilitation treatment group,growth hormone injection+glutamine+dietary fiber intestinal rehabilitation treatment group,the increase of enteral nutritional fluid,the decrease of parenteral nutritional energy,the increase of intestinal moisture absorption,the decrease of defecation times and the appreciation of hemoglobin were significantly increased,and the difference was statistically significant(P<0.05).At the same time,the levels of insulin-like growth factor 1 and insulin-like growth factor binding protein were significantly increased after treatment(P<0.01).Conclusions Nutritional support combined with intestinal rehabilitation can significantly improve the nutritional status and intestinal absorption rate of ultra-short bowel syndrome patients.The use of dietary fiber in the intestinal rehabilitation regimen for ultra-short bowel syndrome patients yields more significant benefits,as evidenced by improved clinical outcomes.