肝移植术后早期肠内肠外营养支持的随机对比研究

摘要

Objecttve To evaluate the effect of early enteral nutrition on the maintenance and improvement of the nutritional status of patients after liver transplantation. Methods Thirty patients were randomly assigned to receive either early enteral nutrition (EN group, 15 patients) or parenteral nutrition (PN group,15 patients) 1～7 days after liver transplantation. Patients were given isonitrogenous and isocaloric intakes. Indicators of nutritional state were tested before operation and on postoperative day 1 and 8. Nitrogen balance was calculated daily. Statistics were made in infection rate and complication rate of nutritional support after operation. Results On postoperative day 8,the levels of serum albumin and pro-albumin in EN group were higher than those in PN group,the levels of total bilirubin,glutamic pyruvic transaminase,glutamic oxalacetic transaminase and blood glucose in EN group were lower than those in PN group(P＜0.05 or P＜0.01) ,and the rate of bile flow in EN group was higher than that in PN group (P＜0.05). From postoperative day 4,nitrogen balance in EN group was superior than that in PN group(P＜0.05).Cumulative nitrogen balance in EN group was superior than that in PN group 7 days after operation(P＜0.01). Anal exhaust time and hospital stay were shorter and the cost of nutrition was less in EN group than those in PN group(P＜ 0.05 or P＜0.01). The infection rate in EN group was lower than that in PN group(P＜0.05). There were no severe complications in EN group.Conclusion EN support is safe and feasible after liver transplantation. Compared with PN support,EN support can efficaciously ameliorate the postoperative nutritional status of patients,accelerate the recovery of liver function, reduce the rate of postoperative infection, and decrease the in-hospital cost.%目的 观察早期肠内营养(enteral nutrition,EN)对维持和改善肝移植术后患者营养状态的影响.方法 将30例肝移植术后早期(术后1～7 d)患者,按随机数字表法分成肠外营养(parenteral nutrition,PN)组、EN,每组各15例,各组营养支持均为等热量和等氮量.各组患者分别于术前、术后第1天、术后第8天检测营养指标,测定术后每天氮平衡并计算累计氮平衡,统计术后感染及营养支持并发症的发生率,进行对照研究.结果 术后第8天,EN组的白蛋白和前白蛋白水平显著高于PN组(P<0.05);总胆红素、谷丙转氨酶和谷草转氨酶比较,EN组显著低于PN组(P<0.01);EN组的血糖水平及胆汁引流量显著优于PN组(P<0.05).术后第4天起,患者每日氮平衡比较,EN组显著优于PN组(P<0.05);术后7 d累计氮平衡比较,EN组显著优于PN组(P<0.01).术后早期感染比较,EN组显著低于PN组(P<0.05).肛门排气时间和平均营养支持费用比较,EN组显著低于PN组(P<0.01).EN组的住院时间显著低于PN组(P<0.05).EN组无严重营养支持并发症的发生.结论 肝移植术后早期的肠内营养营养支持治疗是安全、可行的,与PN相比,EN能更有效地改善患者术后营养状况,促进移植肝的功能恢复,降低术后感染率和医疗费用.