肠瘘病人肠内营养需要量的临床研究

Enteral nutrition needs of patients with intestinal fistulas

目的 研究适当提高肠内营养能量与蛋白质的供给对重度营养不良的肠瘘病人营养状况、能量代谢和脏器功能的影响。方法 选择 2 0 0 1年 5月至 2 0 0 2年 3月的肠瘘病人 2 0例 ,随机分为两组 ,两组病人均给予百普素。对照组病人总热量按 1 5×静息能量消耗 (REE)供给 ,研究组病人按 2 0×REE供给。观察在 15d内两组病人的营养状况、能量代谢和脏器功能的变化。结果 在 15d的营养支持后研究组病人体重增加了 2 0kg ,而对照组病人仅增加 1 3kg。进行营养支持后两组病人的REE无明显变化 ,但呼吸商 (RQ)逐渐增高 ,在第 5、10、15天有显著变化 (P <0 0 1) ,在第 15天 ,研究组RQ达到 0 91,显著高于对照组 (P <0 0 5 )。两组病人在底物氧化率方面差异无显著性意义。在第 10和 15天血清前白蛋白、转铁蛋白、纤维连接蛋白、白蛋白浓度较营养支持前有显著增加 ,且研究组均显著高于对照组。两组病人血糖、血脂和肝肾功能均无明显改变。结论 适量提高肠瘘病人肠内营养的热量和蛋白质供给量可迅速地改善重度营养不良肠瘘病人的营养状态 ,且不会引起代谢紊乱和脏器功能损害。

Objective To study the effect of different enteral nutrition (EN) regimes on the nutritional and metabolism status of the malnourished patients with intestinal fistulas. Methods Twenty malnourished patients with intestinal fistulas during May 2001 to March 2002 were selected and randomized into two groups, control group receiving 1.5×resting energy expenditure (REE) total energy, and test group receiving 2.0×REE total energy. All the patients in two groups received Pepti-2000 as EN product for 15 days. Body weight, indirect calorimetry,serum levels of albumin,prealbumin,transferrin, fibronectin, triglyceride, cholesterol and blood sugar were determined before EN and on 1st,5th,10th,15th day after EN respectively. Results After 15 days of enteral nutrition support, the patients of test group gained 2.0 kg body weight, and the patients of control group gained 1.3 kg. Serum albumin, prealbumin, transferrin and fibronectin increased significantly in both groups compared with those before EN, on 10th and 15th day after EN, and the test group was significantly higher than control group. Respiratory quotient(RQ) increased significantly in two groups compared with that before EN, on 5th, 10th and 15th after EN. The RQ of test group achieved 0.91, which was higher than control group on 15th day after EN.There was no change of REE, oxidation rate of glucose, lipid and protein and serum triglyceride, blood sugar, cholesterol, and function of liver and kidney between two groups. Conclusion These results suggest that intake of total energy of 2.0×REE EN can improve nutritional status of malnourished patients more effectively than total energy of 1.5×REE EN, and no metabolism complication and lesion of organ function will occur.