不同营养方式对胰十二指肠切除术后患者感染的影响  

Effect of different nutrition methods on postoperative infectious complications after pancreaticoduodenectomy

作　　者：谢琦[1] 金慧成[1] 居同法[1] 周春华[1] 

机构地区：[1]杭州市第一人民医院胃肠外科,浙江杭州310000

出　　处：《中华医院感染学杂志》2014年第3期698-700,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医学会临床科研基金项目(2011ZYC-A28);杭州市科技局医疗卫生科研基金项目(20120633B02)

摘　　要：目的探讨不同营养方式对胰十二指肠切除术后患者感染的影响,以期为预防及降低胰十二指肠切除术后感染提供参考依据。方法选取行胰十二指肠切除术的患者60例,依据数字表格法分为肠内营养组与肠外营养组每组各30例,在24h内分别接受肠内营养及肠外营养,时间7d,检测患者术前、术后1d、术后7d谷氨酸转移酶(ALT)、总胆红素(TBIL)、白蛋白(AIB)变化,内毒素及(1-3)-β-D葡聚糖浓度水平变化,术后感染发生率。结果术后7d肠内营养组患者ALT(31.74±9.03)U/L、TBIL(19.39±7.13)μmol/L,肠外营养组患者分别为(47.27±11.02)U/L、(25.48±13.09)μmol/L,两组比较差异有统计学意义(P<0.05);术后7d肠内营养组内毒素浓度(60.38±10.34)pg/ml、(1-3)-β-D葡聚糖浓度(194.22±26.48)pg/ml,肠外营养组患者分别为(104.63±32.47)、(284.67±42.58)pg/ml,两组比较差异有统计学意义(P<0.05);术后感染率肠内营养组患者为16.67%、肠外营养组为46.67%,两组比较差异有统计学意义(P<0.05)。结论胰十二指肠切除术后早期采用肠内营养较肠外营养更能明显改善患者肝功能及全身营养状况,可降低术后感染的发生。OBJECTIVE To investigate the effect of different nutrition methods on the postoperative infections after panereaticoduodenectomy, in order to provide evidence of preventing and reducing infectious complications after resection of pancreatic duodena. METHODS A total of 60 patients underwent resection of pancreatic duodenal were selected and divided into enteral nutrition group and parenteral- nutrition group based on the digital form, each group 30 eases, received enteral nutrition and parenteral nutrition respectively within 24 h in 7 days. The change o{ gIutamic acid transaminase （ALT）, total bilirubin （TBIL）, albumin （AIb）, and the concentration levels change of endotoxin and（1-3）-13-D glucan, and also the change of infectious complications after surgery of patients in 1 d before and after the operation and 7 d after the operation were detected. RESULTS The differences were statistically significant（P〈0. 05） between ALT（31. 74 ± 9. 03） U/L, TBIL（19. 39 ± 7. 13）μmol/L in enteral nutrition group and ALT（47.27±11.02）U/L, TBIL （25.48 ±13.09）μmol/L in parenteral nutrition group in 7 d after surgery. The differences were statistically significant（P〈0.05） between endotoxin （60. 38±10.34） pg/ml, （ 1-3）-β-D glucan（ 194.22 ±26.48） pg/ml in enteral nutrition group and endotoxin （104.63±32.47） pg/ml, （1-3）- β-D glucan （284. 67 ± 42. 58）pg/ml in parenteral nutrition group in 7 d after surgery. The incidence of postoperative infectious complications were 16. 67% and 46. 67% in enteral nutrition group and parenteral nutrition group, and the difference was statistically significant （P〈0. 05）. CONCLUSIONS Postoperative early enteral nutrition in patients underwent pancreaticoduodenectomy can obviously improve the patienfs liver function and nutritional status, which could also reduce the postoperative infectious complications.

关 键 词：胰十二指肠切除术 肠内营养 肠外营养 感染 

分 类 号：R181.32[医药卫生—流行病学]