肠外瘘合并胆或胰外瘘时的营养支持研究  

Nutritional support in patients with gastrointestinal fistulas and biliary or pancreatic fistulas

作　　者：程黎阳[1] 张玉新[2] 李艳华[2] 石英[2] 

机构地区：[1]第一军医大学解剖教研室,广东广州510000 [2]广州军区广州总医院普外科,广东广州510010

出　　处：《肠外与肠内营养》2002年第1期9-11,共3页Parenteral & Enteral Nutrition

摘　　要：目的 :研究肠外瘘合并胆或胰外瘘时的营养支持方法及其作用。　方法 :2 3例肠外瘘合并胆或胰外瘘病人行TPN→PN +EN→TEN→EN +口服饮食序贯营养支持。收集各阶段的营养物质供给量、天数、所占比例及各营养支持阶段末期的肝酶谱 ;统计肠内营养给予途径、全组病例的预后及并发症发生情况 ;比较TPN支持前、TEN支持后 1 5天病人的体重、上臂中点周径、血清总蛋白、白蛋白和前白蛋白浓度。　结果 :2 3例病人住院总天数为 1 498天 ,使用TPN 90 1天 (60 1 % ) ,供给非蛋白质热量 (1 35 .9± 2 3 .4)kJ/(kg·d) ,氮 (0 .2 1± 0 .0 6) g/(kg·d) ;使用PN +EN 445天 (2 9.7% ) ,供给非蛋白质热量 (1 2 3 .4± 1 4 .2 )kJ/(kg·d) ,氮 (0 .1 8± 0 .0 3) g/(kg·d) ;使用TEN 1 52天 (1 0 .2 % ) ,供给非蛋白质热量 (1 1 6 .3± 1 9.6)kJ/(kg·d) ,氮 (0 .1 7± 0 .0 4 ) g/(kg·d) ,肠内营养途径依次是鼻肠管1 3例 ,空肠造口管 5例 ,堵瘘 3例 ,鼻胃管 2例。全组死亡 4例 ,治愈 1 9例 ;中心静脉导管感染 2例 ,肝酶谱改变 6例 ,腹胀、腹泻 3例 ;TEN支持后阶段营养指标明显改善。　结论 :TPN→PN +EN→TEN→EN +口服饮食的序贯营养支持模式是肠外瘘合并胆或胰外瘘病人的合理、有效营养支持方法 。Objectives:To investigate the model and effect of nutritional spport in patients with gastrointestinal fistulas and biliary or pancreatic fistulas. Methods:Step by step nutritional spport was studied in 23 patients with gastrointestinal fistulas and biliary or pancreatic fistulas.The calorie and days provided by different ways of nutritional support and routes of enteral nutrition were reviewed.The nutrition state was evaluated in all cases before TPN and after TEN.Liver functions were observed at the end of every phase of nutrition support. Results:The total hospitalization days of 23 patients were 1 498.TPN,PN+EN and TEN days were 901(60.1%),445(29.7%) and 152(10.2%) respectively,providing non protein calorie of 32.5±5.6,29.5±3.4 and 27.8±4.7 kJ/(kg·d).The routes of enteral nutrition were nasal jejunum tube (13 cases),jejunostomy (5 cases) and nasal gastric tube(2 cases).4 patients died and 19 patients recovered.The nutrition state were significantly improved after nutrition treatment. Conclusions:TPN→PN+EN→TEN→EN+oral feeding was a model of step by step nutritional support,which was effective in patients with gastrointestinal fistulas and biliary or pancreatic fistulas.PN remains the main way providing nutrition support,while EN should be used as soon as possible.

关 键 词：肠外瘘 胆外瘘 胰外瘘 肠外营养 肠内营养 

分 类 号：R459.3[医药卫生—治疗学]