肠内营养对外科手术患者血液内毒素水平的影响  

Influence of enteral nutrition on the level of blood endotoxin in patients undergoing surgery

作　　者：陈大伟[1] 张一楚[1] 费哲为[1] 骆明德[1] 蔡威[2] 汤庆娅[2] 夏韶民[2] 冯一[2] 

机构地区：[1]上海第二医科大学附属新华医院普外科,200092 [2]上海第二医科大学附属新华医院临床营养中心

出　　处：《中国临床营养杂志》2001年第4期227-229,共3页Chinese Journal of Clinical Nutrition

摘　　要：目的　探讨肠内营养降低外科手术患者血液内毒素水平的可能性。　方法　 41例接受外科大手术患者随机分 2组。其中肠内营养组 2 1例 ,肠外营养组 2 0例。术后第 1d开始行肠内或肠外营养支持。术前、术后第 3d和第 8d抽血查白蛋白、纤维连接蛋白、转铁蛋白、r GT、SGPT、胆红素以及内毒素。　结果　两组患者均未出现吻合口漏、腹腔感染等严重并发症。术前两组各项指标差异均无显著性 (P >0 .0 5 )。术后第 3d和第 8d ,两组蛋白指标差异无显著性意义 (P >0 .0 5 )。术后 ,肠外营养组r GT水平持续升高 ,而肠内营养则抑制了r GT的升高 ,术后第 8d两组r GT水平有非常显著性差异 (P <0 .0 1)。两组SGPT和胆红素在手术前后无显著性变化 (P >0 .0 5 )。术后第 3d ,EN组内毒素值有轻度升高 ,至术后第 8d开始下降。而PN组在术后第 3d ,内毒素值也开始升高 ,升高的幅度较EN组要大 (P <0 .0 1) ,术后第 8dEN组内毒素有轻度下降 ,PN组内毒素则继续升高 ,两者相比差异有非常显著性意义 (P <0 .0 1)。　结论　和肠外营养相比 ,肠内营养能降低外科手术患者血液内毒素水平。Objective To investigate whether enteral nutrition decreases the level of blood endotox in patients undergoing surgery,compared with the parente al nutrition. Methods Forty-one patients undegoing major abdominal surgery were randomized into enteral nutrition group(n=21) and parenteral nutrition group(n=20).On the day 1 postoperatively,the patients received either enteral nutrition or parenteral nutrition.Blood samples were obtained and the level of albumin,transfferin,fibronectin,γ-GT,ALT,bilirubin and endotoxin were measured on day 0,day 3 and day 8 postoperatively. Results No serious side-effects and complications such as anastomosis fistula and abdominal infection were observed in both groups.There were no significant differences between two groups preoperatively.The level of proteins in both groups has no significant difference on day 3,day 8 postoperatively.The patients receiving parenteral nutrition had an increasing in γ-GT after the operation.There was a significant difference in the level of γ-GT between two groups on the day 8 postoperatively.ALT and bilirubin had no significant changes during the period.The level of endotoxin in enteral nutrition group increased on day 3 postoperatively,and decreased on day 8 postoperatively.The level of endotoxin in parenteral nutrition group began to increase on day 3 postoperatively,and continued to increase on day 8 postoperatively.There was a significant difference between two groups in the level of endotoxin on day 3 postoperatively and on day 8 postoperatively( P < 0.01 ). Conclusions Compared with the parenteal nutrition,enteral nutrition can decrease the level of blood endotoxin in patients undergoing surgery.

关 键 词：肠内营养 肠外营养 内毒素 外科手术 

分 类 号：R459.3[医药卫生—治疗学] R61[医药卫生—临床医学]