百普素对肠瘘病人营养支持的效果观察

Analysis of efficacy and sensitivity of monitoring index during enteral nutrition with Pepti-2000 Variant in patients with gastrointestinal flstulas

目的 :观察用短肽型要素 (百普素 )对肠瘘病人进行全肠内营养支持 (TEN)的疗效和了解各类营养指标的敏感性。 方法 :用百普素对 10例肠瘘病人行TEN ,供给非蛋白热量 (NPC) 14 6kJ/(kg·d) ,氮 (N) 0 .2 5g/(kg·d) ,于肠内营养支持前、支持后第 7天、第 2 8天分别测体重、血清白蛋白、前白蛋白、转铁蛋白、纤维连结蛋白、血肌酐、尿素氮、胆固醇、三酰甘油等指标。 结果 :TEN 7天后血清前白蛋白、纤维连结蛋白显著升高 (P <0 .0 5 ) ,体重、血清白蛋白、转铁蛋白、胆固醇、三酰甘油改变差异不显著 (P >0 .0 5 )。TEN 2 8天后体重显著升高 (P <0 .0 0 1) ,血清白蛋白、转铁蛋白、前白蛋白、纤维连结蛋白、胆固醇、三酰甘油增高 ,差异显著 (P <0 .0 5 )。 结论 :百普素行TEN能改善肠瘘病人的营养状况。血清纤维连结蛋白与前白蛋白是评估营养支持短期疗效的敏感指标。血清白蛋白、转铁蛋白、血脂可作为营养支持中长期疗效评价的参考指标。

Objectives:To observe the efficacy of enteral nutrition with short peptide elemental diet(Pepti 2000) in patients with gastrointestinal fistulas and evaluate the sensitivity of nutrition associated index in nutrition monitoring. Methods:Ten cases with gastrointestinal fistulas were administered total enteral nutrition(TEN).They received 146 kJ/(kg·d) of non protein calorie(NPC) and 0.25 g/(kg·d) of nitrogen per day. Body weight,serum albumin, transferrin(TFN), prealbumin(PA),fibronectin(FN),triglyceride and cholesterol were monitored on before and 7th and 28th after TEN. Results:Seven days after TEN,serum PA and FN levels rised significantly( P <0.05),but the changes of body weight, serum albumin,TFN, triglyceride and cholesterol were not significant.Twenty eight days after TEN,body weight increased significantly( P < 0.01 ),serum albumin,TFN,PA,FN,triglyceride and cholesterol levels showed a rise significantly( P < 0.05 ). Conclusions:Enteral nutrition support with short peptide elemental diet is effective in improving the nutritional status of patients with gastrointestinal fistulas.FN and PA may be the most sensitive parameters for early assessment of nutritional intervention.Serum albumin,TFN,triglyceride and cholesterol are more useful in assessing the efficacy of medium or long term nutrition support.