早期肠内营养对肝移植术后患者营养支持疗效的前瞻、随机、对照研究  

Efficacy of early enteral nutrition in patients after liver transplantation:a prospective,randomized,controlled clinical trial

作　　者：鱼晓波[1] 夏强[1] 张建军[1] 陈小松[1] 张明[1] 李齐根[1] 罗毅[1] 沈从欢[1] 邢天宇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院器官移植中心,上海市第一人民医院普外科200127

出　　处：《上海医学》2006年第8期522-526,共5页Shanghai Medical Journal

摘　　要：目的观察早期肠内营养(EN)对维持和改善肝移植术后患者营养状态的影响。方法选择肝移植术后进行营养支持的成年患者40例随机进入EN组和完全胃肠外营养(PN)组,每组20例,两组营养支持均等热量、等氮量。分别于术前及术后第1、8天检测营养状态指标,营养支持期间每日测定氮平衡,并计算累计氮平衡,统计术后感染率和营养支持并发症的发生率。结果术后第8天,EN组白蛋白为(39．8±3．9)g/L,明显高于PN组的(35．7±3．5)g/L(P＜0．05)；血糖为(7．1±0．4)mmol/L,明显低于PN组的(10．5±0．5)mmol/L(P＜0．05)；肛门排气时间为(65．0±12．8)h,明显短于PN组的(98．0±9．6)h(P＜0．01)；平均营养费用为(4800±530)元,明显少于PN组的(11300±1120)元(P＜0．01)。术后第3天起EN组每日氮平衡与PN组的差异有显著性(P＜0．05),EN组的累计氮平衡为(-22．077±26．61 6)g,显著高于PN组的(-109．549±40．937)g (P＜0．01)。EN组血液、肺部、消化道等处感染率明显低于PN组(P＜0．05)。EN组营养支持无严重并发症发生。结论肝移植术后EN安全、可行。与PN支持相经,EN可更有效地改善术后患者的营养状态,促进移植肝功能的恢复,且可减少术后感染并发症的发生,降低住院费用,具有明显的优越性。Objective To evaluate the efficacies of early enteral nutrition in patients after liver transplantation. Methods A randomized controlled clinical trial was conducted on comparing the roles of early enteral nutrition （EN） group with parenteral nutrition （PN） group in 40 patients after liver transplantation. The isonitrogenic and isocaloric intakes were performed in the two groups. Nutritional state tests before operation and 1st and 8th day after operation were analysed. Nitrogen balance was measured daily. Statistics were made in infection rate and complication rate of nutritional support after operation. Results The serum albumin in EN group was higher than that in the PN group, and the blood glucose was lower than that in the PN group （P〈0.05）. The time of gas passage through anus in EN group was shorter and cost of nutrition was less than those in the PN group （P〈0.05）. Nitrogen balance was superior in EN group than that in the PN group. The infection rates of blood, lung, gut in the EN group were lower than those in the PN group （P〈0.05） respectively. There was no severe complications of nutritional support in the EN group. Conclusion EN is safe and feasible after liver transplantation. Comparing with PN support, EN support can ameliorate more efficaciously the nutritional status of the patients undergone liver transplantation, accelerate the recovery of liver function, reduce the rate of postoperative infection, and decrease the inhospital cost.

关 键 词：肝移植 肠内营养 肠外营养 

分 类 号：R657.3[医药卫生—外科学]