目的 探讨梗阻性黄疸患者术后早期肠内营养和肠外营养治疗的疗效和安全性.方法 选择2009年10月-2010年6月在我院肝胆病区住院的梗阻性黄疸且行手术治疗的患者40例,随机分为肠内营养组和肠外营养组,各20例;分别于术后24 h给予肠内营养和肠外营养,共7 d.观察术前、术后8 d患者的一般情况、肝功能、临床营养、并发症等指标的变化.结果 (1)治疗后肠内营养组患者肠功能恢复时间较肠外营养组显著缩短[(42.5±7.2)h与(56.2±10.4)h],平均营养费用较肠外营养组显著减少[(809.5±45.6)元与(1 209.5±125.3)元],差异均有统计学意义(P＜0.01);而两组的住院时间比较,差异无统计学意义(P＞0.05).(2)两组患者术后肝功能较治疗前显著改善(P＜0.01),且肠内营养组与肠外营养组比较差异亦有统计学意义(P＜0.01).(3)术后8 d肠内营养组患者上臂围、三头肌皮褶厚度及前清蛋白、转铁蛋白水平与肠外营养组比较,差异均有统计学意义(P＜0.05).结论 梗阻性黄疸术后进行早期肠内营养是安全、有效、合理的营养支持方式.%Objective To evaluate the efficacy and safety of early postoperative enteral and parenteral nutrition in patients with obstructive jaundice. Methods Forty patients with obstructive jaundice who underwent operation at our facility between Oct. 2009 and Jun. 2010 were randomized into the EN group and the PN group ( 20 cases each ) . The two groups received isocaloric or isonitrogenous nutritional formulas 24 hours after operation for a total of 7 days. General condition, liver function, clinical complications, and clinical nutritional status before and 8 days after treatment were compared all patients. Results Intestinal function recovery time was significantly shorter and average cost was significantly lower in the EN group than in the PN group ( P <0. 01 ), while average length of hospital stay showed no significant difference between the two groups ( P >0. 05 ) . Liver function in both two groups improved significantly after nutrition ( P <0. 01 ), with significant differences noted between the two groups ( P <0. 01 ) . Upper arm girth, triceps skinfold, prealbumin, and transferin 8 days after surgery were significantly different between the enteral group and the parenteral group ( P < 0. 05 ) . Conclusion Early enteral nutrition is safe, effective and appropriate way in postoperative patients with obstructive jaundice.
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