胰十二指肠切除术后不同营养支持方式营养疗效的临床分析  

Clinical analysis of different nutritional support for patients after pancreaticoduodenectomy

作　　者：石悦[1] 张佳林[2] 葛春林[2] 王凤山[2] 刘树荣[2] 李晓航[2] 刘永锋[2] 

机构地区：[1]中国医科大学附属第一医院干诊科,110001 [2]中国医科大学附属第一医院肝胆外科暨器官移植科

出　　处：《辽宁医学杂志》2013年第4期166-170,共5页Medical Journal of Liaoning

摘　　要：目的对比分析胰十二指肠切除术(PD)后肠内联合肠外营养(EN+PN)支持方式与全肠外营养(TPN)支持方式对改善术后患者营养状态、术后并发症发生率、术后住院时间和住院费用的影响。方法回顾性分析我院自2001年1月至2008年6月122例行PD患者的临床资料,根据术后不同的营养方式分为EN+PN组(n=65)和TPN组(n=57),对比分析两组患者术后血清总蛋白、白蛋白、外周血总淋巴细胞计数等各项营养指标的变化、两组术后并发症发生率、术后住院天数及住院费用。结果两组血清总蛋白、白蛋白和外周血总淋巴细胞计数差异无显著性,其中两组总蛋白和白蛋白随时间推移呈递增趋势,各项指标在术后7天和术后14天均较术后第1天明显增高(P<0.05)。EN+PN组较TPN组并发症发生率降低,EN+PN组的术后平均住院时间较TPN组明显缩短(P<0.05),EN+PN组住院费用较TPN组有降低趋势(P>0.05)。结论 PD后应用EN与PN同样能改善患者的营养状态,两者的营养疗效是相似的。此外,PD后EN+PN支持方式与TPN相比,能够减少术后并发症的发生率,促进胃肠道功能的恢复,缩短患者术后住院时间,降低住院费用,具有独特的优越性。EN+PN是PD后一种理想的营养支持治疗方法,可依据术后患者的具体情况,合理早期应用肠内营养。Objective Compare and analysis the nutritional effect of enteral nutrition combined with parenteral nutrition and total parenteral nutrition after pancreaticoduodenectomy（PD）.Methods 122 patients who underwent pancreaticoduodenectomy were chosen from Jan,2001 to Jun,2008.65 of them are divided as enteral nutrition combined with parenteral nutrition（EN＋PN） group and 57 as total parenteral nutrition（TPN） group.The levels of total serum protein,albumin and total lymphocytes were measured and compared between EN＋PN and TPN groups.And the admitting duration after surgery,the medical costs and the rate of complications were also compared.Results The laboratory data between two groups were no evidently different before or after PD.And on the 7th day in each group,they recovered obviously than that on the 1st day after surgery.The rate of complication in the EN＋PN group was reduced than the TPN group.The average admitting duration was significantly shorter in the EN＋PN group as compared to the TPN group（P0.05）,and the medical costs decreased（P0.05）.Conclusion EN＋PN is safe as the main nutrition support for the early stage after pancreaticoduodenectomy.It should be chose based on the status of the patients.Both of the two nutrition supports can correct the malnutrition after pancreaticoduodenectomy.Furthermore,EN＋PN also can shorten the admitting duration,decrease the medical costs and reduce the rate of complications.So EN＋PN is the first choice as the nutrition treatment for patients who have undergone pancreaticoduodenectomy.

关 键 词：PD 肠内营养 肠外营养 营养支持 

分 类 号：R459.3[医药卫生—治疗学]