摘要
目的:探讨结、直肠手术后早期肠内营养的可行性,并比较肠内与肠外营养的效果。 方法:30例结、直肠术后病人随机分为早期肠内营养(early enteralnutrition,EEN 组)和完全胃肠外营养(totalparenteralnutrition,TPN组)两组,各15 例。EEN 组术后24 h 内经鼻肠管输注肠内营养制剂液体能全力(nutrison fibre),TPN组经外周静脉进行,共7天。 结果:EEN组均完成肠内营养计划,未发生吻合口瘘和腹腔感染。两组术后体重、三头肌皮褶厚度、上臂周径均较术前略低(P< 0.01),但组间比较无差异。两组总淋巴细胞计数、前白蛋白营养支持前后差异不显著,总蛋白、白蛋白、转铁蛋白组间比较均无统计学显著差异,但转铁蛋白TPN组术后8天显著低于术前水平(P<0.01),而EEN组仍维持在术前水平。对肝功能的影响、碱性磷酸酶TPN 组较前显著升高,而EEN前、后无明显改变,术后乳酸脱氢酶TPN 组高于EEN 组(P< 0.05),转氨酶组间比较无显著差异,总胆红素TPN、EEN 前后均无显著改变。两组术后氮监测1周,均表现为负氮平衡。EEN、TPN 组肠功能恢复时间分别为(2.2±0.7)天、(2.9±1.0)天(P< 0.05),排便时间各为(3.0±1.3)天、(5.4±2.0)天(P< 0.01)。两组切口愈合情况、住院天数无差异(P> 0.05)。平均住院费用/药物费用EEN组低于TPN 组(P< 0.05)
Objectives:The purpose of this study was to evaluate the feasibility of early postoperative enteral nutrition(EEN) in colorectal surgery and compare metabolic effects of EEN versus total parenteral nutrition(TPN). Methods:Thirty patietns undergone colorectal surgery were divided into two groups randomly.Fifteen patients in EEN group had a naso jejunal tube inserted during the operation.The enteral feeding was started within the first 24 hours postoperatively with Nutrison Fibre and continued for consecutive 7 days.EEN provided 0.18 g/kg·d of nitrogen and 104.5 kJ/kg·d of non protein energy.In fifteen patients of PN group total parnteral nutrition was provided via peripheral vein for 7 days.Anthropometric and biochemical parameters and viscreal functions were monitored. Results:There were no significant differences between the two groups in body weight,serum total protein,albumin,and prealbumin.Serum transferrin maintained stable in EEN group,and decresed significantly in PN group.By the end of the study cumulated nitrogen balance in EEN and PN group was -19.17±15.66 gN/7 d and -27.57±12.43 gN/7 d( P >0.05),respectively.Increased serum levels of lactate dehydrogenase(LDH) and alkaline phosphatase(AKP) were observed after PN support.There were no statistical differences in wound healing,complications and duration of hospitalization between the two groups.The overall cost of enteral nutrition was significantly lower than that of standard PN( P <0.05).The audible bowel sounds and bowel movement recovered earlier in EEN group than in PN group( P <0.05). Conclusions:The early postoperative enteral nutrition was well tolerated in the patietns undergone colorectal surgery.In comparison with PN the metabolic effect was similar in EEN with less disturbance on liver function.The early enteral feeding with formula containing fiber may help to maintain the bowel functions and gut barrier integrity.
出处
《肠外与肠内营养》
CAS
2000年第1期23-27,共5页
Parenteral & Enteral Nutrition
关键词
肠内营养
完全胃肠外营养
结直肠手术
代谢
Enteral nutrition
Parenteral nutrition
Colorectal surgery,Metabolism
