目的 探讨早期肠内营养对食管癌术后患者肠屏障功能和细菌易位的影响.方法 120例食管癌术后患者随机分成早期肠内营养(EN)组、胃肠外营养(PN)组.术后第1天、术后第4天及术后第8天检测血浆内毒素水平、D-乳酸水平及二胺氧化酶(DAO)水平,术前及术后第1～7天每日行外周血细菌聚合酶链反应(PCR)检测及培养.结果 术后第8天EN组内毒素、D-乳酸及DAO水平显著低于PN组(P＜0.01).120例食管癌术后患者PCR检测外周血细菌阳性率45.83％ (55/120),术后第4天起两组PCR检测阳性率差异有统计学意义(P＜0.05).55.50％ (66/120)患者出现全身炎症反应综合征(SIRS).术后血细菌培养阳性率21.67％ (26/120).PCR检测外周血细菌阳性组感染并发症发生率为47.27％ (26/55),阴性组均未发生感染(0/65),两者差异有统计学意义(P＜0.05).结论 食管癌术后施行早期EN能有效地维护肠黏膜屏障功能,防止细菌及内毒素易位,减少术后感染的发生.%Objective To investigate the impact of early entera] nutrition (EN) on gut mucosal barrier and bacterial translocation after esophagectomy. Methods A randomized controlled clinical trial was conducted in 120 patients after esophagectomy, which were equally divided into two groups and treated with enteral nutrition (EN group) and parenteral nutrition (PN group). The levels of plasma endotoxin, D-lactate, diarnine oxidase (DAO) were detected on the first, fourth, eighth day after operation. The bacteria in the peripheral blood was cultured and tested by PCR before operation and from the first day to the seventh day after operation. Results On the eighth day after operation, the levels of D-lactate, DAO and endotoxin were significantly lower in the EN group than the PN group (P<0.01). The total positive rate of the bacterial in the peripheral blood was 45.83% (55/120), and the positive rate showed statistically significant difference between the two groups from the fourth day after operation (P<0.05). 55,50% (66/120) patients showed systemic inflammatory response syndrome (SIRS). Hemoculture examination detected bacterial positive in 26 patients (21.67%), In PCR-positive patients, 47.27% (26/55) developed infectious complications, while none of PCR-negative patients did (P<0.01). Conclusion Early EN plays an important role in the recovery of gut mucosal barrier function after esophagectom, and can reduce the bacterial transtocation in gut and the occurrence of infectious complications.
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