早期肠内营养支持对胃肠肿瘤术后患者肠黏膜通透性的影响

The Effect of Postoperative Early Enteral Nutrition on Intestinal Permeability for the Patients with Gastrointestinal Malignancy

目的研究术后早期肠内营养支持对胃肠肿瘤患者肠黏膜通透性的影响。方法20例经病理证实为胃肠肿瘤的患者随机分为PN组和EN组。PN组术后行TPN支持,能量为105kJ·kg-1·d-1,氮入量0.2g·kg-1·d-1。EN组术后第1天起经鼻饲管(放置于Treitz韧带下或空肠输出袢下30cm)输注能全力,量由500ml/d递增至1500ml/d,速度由21ml/h递增至63ml/h。分别于术前1d及术后第8天分别给患者口服甘露醇5g和乳果糖10g,收集患者随后6h的全部尿液,测量6h尿中甘露醇排除率与乳果糖排除率之比值(lactulose/mannitolratio,L/M比值)。结果20例胃肠肿瘤患者术前L/M值为0.047±0.025,与正常人群的L/M值相比差异有极显著性(P<0.01)。术前PN组的L/M比值为0.050±0.030,EN组的L/M比值为0.044±0.023,两组间差异无显著性(P>0.05)。术后第8天分别经一段时期的EN和PN支持后,PN组的L/M比值为0.105±0.034,PN组的L/M比值为0.084±0.40,两组分别与术前相比差异有极显著性(P<0.01),两组间相比差异无显著性(P>0.05)。结论术后早期短程应用能全力肠内营养支持对于胃肠肿瘤患者的肠黏膜通透性的影响与肠外营养支持相比差异无显著性。

Objectives To elucidate the effect of early enteral nutrition support (ENS)on intestinal permeab-ility of postoperative gastrointestinal (GI)cancer patients.Methods 20patients with GI cancer diagnosed pathologically were randomly divided into two groups:enteral nutrition group (EN-group,10cases),parenteral nutrition group(PN-group,10cases).PN-group was given total parenteral nutrition(TPN),105kJ·kg -1 ·d -1 of energy,N0.2g·kg -1 ·d -1 .In EN-group,the naso-intestinal tube was placed30cm distal to ligament of Treitz or jejunal export loop,throught which Nutrisonwas infused since the1 st postoperative day,the infused volume was gradually added from500ml /d to1500ml /d,the infusing rate was step by step increased from20ml /h to60ml /h.Intestinal permeability was evaluated using the lactulose/mannitol test on the first preoperative day and8 th postoperative day(POD).The test solution containing10g lactulose and5g mannitol was administered with40ml of water.Results Postoperatively,the L/M ratio of the GI cancer patients were significantly increased(P<0.01)than the normal value.On POD8,the L/M ratio of PN group was not statistically different from EN group.The L/M ratio of all the patients on POD8(PN:0.105+/-0.034,EN:0.084+/-0.040)had a significant elevation (P<0.01)vs preoperative value.Conclusion After GI surgery for malignancy,early postoperative enteral nutrition compared with parenteral nutrition was not siginificant different in altering intesti nal permeability.