早期肠内营养对胃癌行全胃切除术后肝功能的影响

Effect of early enteral nutrition on liver functions in gastric carcinoma patients after total gastrectomy

目的探讨胃癌患者术后实施早期肠内营养对肝功能是否具有保护作用。方法80例胃癌根治术患者随机分为肠内营养组(EN组)与肠外营养组(PN组),每组40例。EN组术后24h以内管喂肠内营养液能全力,PN组给予等氮、等热卡的肠外营养,总热量为105-126kJ.kg-1.d-1,营养支持共7d。分别于术前,术后第3、8天查血生化指标变化。结果术后第3天两组患者的白蛋白、前白蛋白、转铁蛋白等营养指标均下降,术后第8天有所恢复,EN组前白蛋白、转铁蛋白水平明显高于PN组(P<0.05)。术后第3天两组患者的总胆红素(TB)、直接胆红素(DB)、间接胆红素(IB)均升高,术后第8天EN组TB、DB、IB降至术前水平,而PN组继续升高,明显高于EN组(P<0.05)。两组患者的丙氨酸转氨酶、天冬氨酸转氨酶于术后第3、8天均持续升高,但PN组较EN组升高更明显(P<0.05)。结论胃癌术后早期肠内营养可促进肝脏合成蛋白,减轻术后肝功能损害,有利于术后胆红素代谢。

Objective To determine the effect of early enteral nutrition(EN)on liver function in gastric carcinoma patients after total gastrectomy.Methods 80 patients who underwent the same elective operation for gastric carcinoma were prospectively randomized into early EN group,in which patients received nasoduodenal infusion with Nutrison from the 1st postoperative day and parenteral nutrition(PN)group.The nutritional goal was 105-126kJ/(kg·d).Both groups received isocaloric and isonitrogenous nutritional formulas on the same postoperative day.Several blood chemistries were measured preoperatively and on the 3rd and 8th postoperative day.Results There was no significant difference in gastric carcinoma between these two groups.On the 8th postoperative day,serum prealbumin and transferrin levels in the EN group were significant higher than those in the PN group.The serum levels of total bilirubin,direct bilirubin,and indirect bilirubin were significantly attenuated in the EN group after operation.Activities of ALT and AST in sera were significantly higher in the PN group after operation.Conclusion Early EN may improve hepatic protein synthesis,attenuate the impairment of hepatic function after operation,and facilitate bilirubin metabolism.