肠内营养对老年术后患者营养代谢和肠粘膜屏障的影响  

The clinical study on the enteral nutrition improving the nutritional metabolism and intestinal mucosa barrier of aged post-traumatic patients.

作　　者：朱明炜[1] 韦军民[1] 赵旭[1] 曹金铎[1] 唐大年[1] 陈悦[1] 蒋朱明[2] 

机构地区：[1]卫生部北京医院普外科,100730 [2]北京协和医院基本外科

出　　处：《中华老年医学杂志》2002年第1期34-36,共3页Chinese Journal of Geriatrics

摘　　要：目的　评价肠内营养对老年腹部手术后患者营养代谢和肠粘膜通透性的影响。　方法　采用前瞻、随机、对照的方法 ,将 2 5例老年腹部手术患者分为肠内营养组 (肠内组 ,12例 )和肠外营养组 (肠外组 ,13例 ) ,2组患者具有可比性 ;分别给予整蛋白型肠内营养 (力苏 )和等氮、等热卡的肠外营养 ,对其血浆谷氨酰胺浓度、血浆蛋白和累积氮平衡、肠粘膜通透性、免疫球蛋白以及感染有关并发症、营养治疗费用等方面进行观察。　结果　进行 6d的不同营养支持后 ,于术后 10d ,肠内组血浆谷氨酰胺浓度 (5 93± 5 7) μmol·L-1、累积 6d氮平衡 (30± 2 4)mg·kg-1、IgG和IgM分别为 (12 4± 1 9)g·L-1和 (15 0 0± 80 0 )mg·L-1,均高于肠外组 (P <0 0 5 ) ;用药前后甘露醇 /乳果糖 (L/M)比值的变化为 0 0 12± 0 0 11,低于肠外组的 0 0 38± 0 0 2 2 (P <0 0 1) ;血浆蛋白结果相似 ;感染并发症 ,肠内组仅有 1例 ,肠外组 2例 ;肠内组的营养治疗费用为肠外组的 36 6 %。　结论　肠内营养能进一步改善患者营养代谢 ,维护其肠粘膜屏障 ,更为经济和减少感染并发症。Objective To evaluate the effects of enteral nutrition on the nutritional metabolism and the permeability of intestinal mucosa in aged post-traumatic patients. Methods The prospective, randomized and controlled study was designed. Twenty-five aged patients who were performed on abdominal operation were divided into EN group(12) and PN group(13). The two groups were comparable. EN group received protein nutrition (Fresubin neutral), PN group received parenteral nutrition of equal nitrogen and equal calories with the EN group. The plasma glutamine concentration, plasma protein, accumulative nitrogen balance, intestinal mucosal permeability, immunoglubulin, the infection related complications and the cost for nutritional support were observed and compared. Results After different nutritional support for 6 days, the plasma glutamine, accumulative nitrogen balance, IgG and IgM of EN group were all higher than that of the PN group and showed statistically significant difference (P>0.05). Change of L/M ratio (0.012±0.011 vs 0.038±0.022) was lower than PN group. The plasma protein results were similar in two groups. One patient in EN group and 2 patients in PN group showed infection related complications. The cost of nutritional support in EN group was 36.6% of the PN group. Conclusions EN improves the nutritional metabolism, supports intestinal mucosa barrier, and decreases the complications, and also, was more economical.

关 键 词：肠营养 肠粘膜 腹部手术 老年 营养代谢 

分 类 号：R459.3[医药卫生—治疗学]