上消化道穿孔术后早期肠内营养治疗的临床价值研究

摘要

Objective:To study the clinical effect of postoperative early enteral nutrition in treatment of patients with upper enteron perforation.Methods:72 cases of patients with upper enteron perforation received operation in our hospital were analyzed.Patients were divided into observation group(EEN,n=32) and control group(no EEN,n=40) by whether received postoperative early enteral nutrition (EEN) treatment.The inflammatory mediators,nutritional indexes and intestinal dysfunction indexes of peripheral blood in two groups before and after 1 weeks were detected and compared.Results:The patients in the observation group had shorter postoperative hospital stays than that of patients in the control group (12.5±3.5 vs.15.6±5.2),the difference was statistically significant(t=2.888,P<0.01).After 1 week treatment,the levels of peripheral blood C reactive protein(CRP) and IL-6 had a downward trend,compared with preoperative,the difference was statistically significant(P<0.05),and levels in patients of the observation group were lower than that in the control,the difference was statistically significant(P<0.05).After 1 week of operation,the peripheral blood hemoglobin,albumin and prealbumin levels decreased in different degrees in the control group(P<0.05) ,and significantly lower than that of the observation group(P<0.05).After 1 week of the treatment,the levels of endotoxin (ET) and D-lactate in peripheral blood in all patients were significantly lower than those before opertaion(P<0.05).However,1 week after operation,the levels of ET and D-lactate in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:For upper enteron perforation patients,the postoperative early enteral nutrition can improve the systemic inflammatory response,nutritional status and intestinal barrier function.%目的:研究术后早期肠内营养在上消化穿孔术后应用的临床效果.方法:分析72例在本院接受手术治疗的上消化道穿孔患者的临床资料,依据患者术后是否采用早期肠内营养(early enteral nutrition,EEN)治疗(术后48 h内)分为观察组(EEN,n=32)及对照组(非EEN,n=40).检测对比两组患者术前及术后1周外周血炎症介质、营养指标及肠功能障碍指标.结果:观察组患者术后住院时间显著短于对照组(12.5±3.5 vs.15.6±5.2),差异具有统计学意义(t=2.888,P<0.01).两组患者术后1周外周血C反应蛋白(CRP)及白介素-6(IL-6)水平均呈现降低趋势,与术前比较差异具有统计学意义(P<0.05),且观察组患者低于对照组,差异具有统计学意义(P<0.05).对照组患者术后1周外周血血红蛋白、白蛋白及前白蛋白水平均不同程度降低(P<0.05),且显著低于观察组(P<0.05).治疗后1周,两组患者外周血内毒素(endotoxin,ET)及D-乳酸水平均较术前显著降低(P<0.05),但观察组患者术后1周ET及D-乳酸水平显著低于对照组(P<0.05).结论:术后早期肠内营养治疗可显著改善上消化道穿孔术后患者系统性炎症反应、营养状况及肠屏障功能.