胃肠外科肠外营养支持治疗中应用多种油脂肪乳对肝功能及相关炎性因子的影响

摘要

目的 分析探讨胃肠外科肠外营养支持治疗中应用多种油脂肪乳对肝功能及相关炎性因子的影响.方法 选择2014年6月-2016年2月海南省中医院外一科接受治疗的90例胃肠外科手术患者作为研究对象,按随机数字表法分为观察组和对照组,各45例.对照组患者应用20％中长链脂肪乳进行肠外营养支持治疗,而观察组患者则应用多种油脂肪乳进行肠外营养支持治疗.观察比较2组患者的临床治疗效果及治疗前后肝功能、炎性因子和细胞免疫的变化情况.结果 经过相应的治疗之后,观察组患者的ICU住院时间、抗生素使用时间均显著短于对照组患者,差异均具有统计学意义(t=8.318、8.156,P＜0.01);观察组患者的术后感染率低于对照组患者,但组间比较差异无统计学意义(x2 =1.947,P＞0.05);2组患者的ALT、TBil水平均较治疗前显著下降(P＜0.01),并且观察组患者ALT下降更为明显(t=7.839,P＜0.01),而TBil差异无统计学意义(t=0.441,P＞0.05);2组患者的Alb水平均较治疗前显著上升(P＜0.01),且组间比较差异有统计学意义(t=2.819,P＜0.01);2组患者的CRP、IL-6、TNF-α水平均较治疗前显著下降(P＜0.05),并且观察组患者下降更为明显(t=24.895、7.266、13.583,P＜0.01);2组患者的CD4+、CD4+/CD8+水平均较治疗前显著上升(P＜0.05),CD8+水平均较治疗前显著下降(P＜0.05),并且观察组患者改善更为明显(t=8.417、6.181、8.913,P＜0.01).结论 胃肠外科手术患者肠外营养支持治疗中应用多种油脂肪乳能够有效提高患者的治疗效果,改善患者的肝功能,降低炎性因子水平,提高细胞免疫功能具有重要的临床意义.%Objective To investigate the effect of different kinds of fat emulsion on liver function and related inflammatory factors.Methods A total of 90 patients with gastrointestinal surgery were selected from June 2014 to February 2016 in Hainan Provincial Hospital of traditional Chinese medicine as the research object,and they were randomly divided into observation group and control group,each with 45 cases.Patients in the control group were treated with 20％ long chain fat emulsion for parenteral nutrition support,while the patients in the observation group were treated with various kinds of fat emulsion.The clinical therapeutic effects,the changes of liver function,inflammatory factors and cell immune function before and after treatment in 2 groups were observed and compared.Results After appropriate treatment,the observation group of patients with ICU in hospital time,antibiotic use time were significantly shorter than the control group,the differences were statistically significant (t =8.318,t =8.156,P ＜ 0.01);infection rate was lower than the control group of patients in the observation group after operation,but there was no significant difference between groups (x2 =1.947,P ＞ 0.05 2);ALT,TBil levels were significantly lower than before treatment (P ＜ 0.05),and the ALT level of patients in the observation group were significantly decreased (t =7.839,P ＜0.01;t =0.441,P ＞0.05);the Alb levels of 2 groups were increased significantly compared with those before treatment (P ＜ 0.01),and there was significant difference between groups (t =2.819,P ＜ 0.01);CRP,IL-6,TNF-α levels were significantly lower than before treatment (P ＜0.05),and the patients in the observation group were significantly decreased (t =24.895,t =7.266,t =13.583,P ＜0.01);the 2 groups of patients CD4+,CD4 +/CD8 + increased significantly compared with those before treatment (P ＜ 0.05),CD8 + levels were significantly lower.than before treatment (P ＜0.05),and the patients in the observation group were more obvious changes (t =8.417,t =6.181,t =8.913,P ＜ 0.01).Conclusion Gastrointestinal surgery in patients with intestinal nutrition support can effectively improve the therapeutic effect of application of various oil emulsion treatment,improve the liver function of patients,reduce the levels of inflammatory factors,enhance cell immune function,has important clinical significance,is worthy of promotion.