肠内营养支持对老年患者术后营养代谢和肠黏膜通透性的影响

摘要

目的：评价肠内营养对老年患者腹部手术后营养代谢和肠黏膜通透性的影响。方法将68例老年腹部手术患者按随机数字表法分为肠内营养组（肠内组）35例和肠外营养组（肠外组）33例，分别给予整蛋白型肠内营养和等氮、等热卡的肠外营养，观察并比较两组患者血浆谷氨酰胺、蛋白和累积氮平衡水平、肠黏膜通透性、血浆免疫球蛋白lgG和IgM水平以及感染有关并发症、营养治疗费用等的差异。结果不同营养支持6d后，肠内组血浆谷氨酰胺（422±54）μmol/L、累积6d氮平衡（30.3±24.0） mg/kg，lgG和lgM分别为（12.4±1.9）g/L和（1450±760）mg/L，均高于肠外组（均P＜0.05）；用药前后甘露醇/乳果糖比值的差值为0.036±0.019，高于肠外组的0.013±0.011（P＜0.01）；肠内组发生感染并发症3例，肠外组5例；肠内组的营养治疗费用低于肠外组（P＜0.01）。结论肠内营养能进一步改善患者营养代谢，维护其肠黏膜屏障，减少感染并发症的发生，且更为经济。%Objective To evaluate the nutritional metabolism and intestinal permeability in elderly patients with postoper-ative enteral nutrition(EN) or parenteral nutrition(PN). Methods Sixty eight elderly patients undergoing abdominal operation were randomly divided into EN group(n=35) and PN group (n=33). EN group received protein nutrition (Fresubin neutral), PN group re-ceived protein nutrition of equal nitrogen and equal calories with the EN group. The plasma glutamine concentration, plasma pro-tein and accumulated nitrogen balance, intestinal permeability, immune globulin (IgG, IgM) and infection- related complications, nutritional treatment costs were documented and compared. Results After 6d of nutritional support, the plasma glutamine con-centration (422±54μmol/L ), accumulated nitrogen balance(30.3±24.0 mg/kg), IgG (12.4±1.9g/L) and IgM (1450±760Mg/L) in EN group were higher than those in PN group (P<0.05). Change of L/M ratio in EN group was higher than that in PN group (0.036±0.0191,0.013±0.011, P<0.01). One patient in EN group and two patients in PN group presented infection- related com-plications. The cost of nutritional support in EN group was lower than that in PN group(P<0.01). Conclusion Enteral nutrition can improve nutritional metabolisim, support intestinal permeability barrier, decrease the complications and more economical in el-derly patients after abdominal operation.