摘要
目的:基于肠道菌群水平探讨早期益生菌强化肠内营养策略对肝癌术后患者肝功能、营养状态及胃肠功能障碍风险控制的影响。方法:选取我科2022年1月至2024年1月期间107例肝癌术后患者作为研究对象,对照组(n=53)静脉滴注肠内营养乳剂(滴速为80~100 mL·h^(-1)),观察组(n=54)于术后24 h内给予早期肠内营养联合乳酸杆菌属20 mg及双歧杆菌属15 mg治疗,每日3次。于术后第1 d和第14 d采用全自动生化检测仪测定天冬氨酸转氨酶(Aspartate aminotransferase,AST)、丙氨酸转氨酶(Alanine aminotransferase,ALT)、总胆红素(Total bilirubin,TBIL)水平以评判肝功能,检测血清总蛋白(Total protein,TP)、人血清白蛋白(Human serum albumin,HSA)以判断营养状态;采用酶学分光光度计法检测血清肠型脂肪酸结合蛋白(Intestinal fatty acid-binding protein,I-FABP)、二胺氧化酶(Diamine oxidase,DAO)及D-乳酸水平以评判肠道粘膜屏障功能;使用全自动微生物鉴定药敏分析仪检测双歧杆菌、乳酸杆菌水平以评判肠道菌群水平;记录患者术后治疗过程中胃肠功能障碍情况,统计不良反应发生率。结果:干预后,两组患者AST、ALT、TBIL、I-FABP、DAO、D-乳酸、双歧杆菌、乳酸杆菌含量均明显降低,且观察组低于对照组(P<0.05);两组TP、HSA水平均上升,且观察组高于对照组,具有统计学意义(P<0.05);对照组胃肠功能障碍发生率为7.55%;观察组胃肠功能障碍发生率为5.56%,两组比较无差异(P>0.05)。结论:早期益生菌强化肠内营养可优化肝癌术后患者肝功能和营养状态,修复肠粘膜,改善肠道菌群水平及胃肠功能。
Objective:Based on the level of intestinal flora,to explore the effects of early probiotics fortifying enteral nutrition on liver function,nutritional status and risk control of gastrointestinal dysfunction in patients with liver cancer after surgery.Methods:A total of 107 postoperative patients with liver cancer from January 2022 to January 2024 in our department were selected as the study subjects.The control group(n=53)received intravenous infusion of enteral nutritional emulsion(at a rate of 80-100 mL·h^(-1)),while the observation group(n=54)received early enteral nutrition combined with 20 mg of Lactobacillus and 15 mg of Bifidobacterium within 24 hours after surgery,three times a day.On postoperative days 1 and 14,levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),and total bilirubin(TBIL)were measured using an automatic biochemical analyzer to assess liver function,and levels of total protein(TP)and human serum albumin(HSA)were measured to evaluate nutritional status.Serum intestinal fatty acid-binding protein(I-FABP),diamine oxidase(DAO),and D-lactate levels were measured using an enzymatic spectrophotometer to assess intestinal mucosal barrier function.The levels of Bifidobacterium and Lactobacillus were detected using an automatic microbial identification and drug susceptibility analyzer to evaluate intestinal flora levels.Gastrointestinal dysfunction during postoperative treatment was recorded,and the incidence of adverse reactions was calculated.Results:After intervention,the levels of AST,ALT,TBIL,I-FABP,DAO,Dlactate,Bifidobacterium,and Lactobacillus were significantly reduced in both groups,with lower levels in the observation group compared to the control group(P<0.05).The levels of TP and HSA increased in both groups,with higher levels in the observation group compared to the control group,showing statistical significance(P<0.05).The incidence of gastrointestinal dysfunction was 7.55%in the control group and 5.56%in the observation group,with no significant difference between the two groups(P>0.05).Conclusion:Early probiotics enhanced enteral nutrition can optimize the liver function and nutritional status of patients after liver cancer surgery,repair intestinal mucosa,improve intestinal flora level and gastrointestinal function.
作者
李珊珊
陈国勇
王媛
高春辉
Li Shan-shan;Chen Guo-yong;Wang Yuan;Gao Chun-hui(Department of Hepatobiliary and Pancreatic Surgery·Henan Provincial People's Hospital·Henan Provincial Key Laboratory of Medical Nursing,Zhengzhou University People's Hospital,Zhengzhou 450000,China)
关键词
肠道菌群
益生菌强化
肝癌
肝功能
营养状态
Intestinal flora
Probiotic enhancement
Liver cancer
Liver function
Nutritional status
