肝移植术后早期肠内营养不同途径的对比  

Clinical effects of early enteralnutrition via a nasogastric tube vs a gastric-jejunal tube in patients after liver transplantation

作　　者：李晖[1] 郑丹[1] 熊会玲[1] 吴杰[1] 

机构地区：[1]武汉市中心医院消化内科,湖北省武汉市430014

出　　处：《世界华人消化杂志》2014年第19期2784-2788,共5页World Chinese Journal of Digestology

摘　　要：目的:比较肝移植术后不同途径进行早期肠内营养的临床效果.方法:选取本院肝移植患者98例,排除术后1 wk内死亡的患者4例,根据肠内营养方式的不同分为鼻胃管组鼻胃管组(n=44)和胃空肠管组(n=50).鼻胃管组术后采用鼻胃管肠内营养,胃空肠管组采用术后经皮经胃空肠置管肠内营养.分别记录两组患者的营养管开始使用时间、留置时间,放置营养管致并发症情况,肝移植相关并发症及平均住院时间.结果:胃空肠管组营养管开始使用时间明显早于鼻胃管组,且留置时间(97.3 d±9.6 d)明显长于鼻胃管组(25.7 d±5.2 d),差异有统计学意义(P<0.01),而且胃食管返流及胃潴留并发症发生率(胃食管返流:10.00%;胃潴留:14.00%)明显低于鼻胃管组(胃食管返流:27.27%;胃潴留:34.09%),差异有统计学意义(P<0.05).另外,当患者术前Meld评分>15分时,胃空肠管组平均住院时间(31.8 d±6.3 d)明显短于鼻胃管组(36.7 d±5.5 d),差异有统计学意义(P<0.01).结论:肝移植术后采用经皮经胃空肠管肠内营养方式效果明显优于鼻胃管方式,值得在临床治疗中推广.AIM： To compare the clinical effects of different ways of early enteral nutrition in patients after liver transplantation. METHODS： Ninety-eight patients who under-went liver transplantation were selected, and 4 cases were excluded because of postoperative deaths within one week. The remaining pa-tients were divided into two groups according to the way of enteral nutrition： nasogastric tube group（n = 44） and gastric-jejunal tube group（n = 50）. The nasogastric tube group adopted a nasogastric tube, and the gastric-jejunal tube group underwent percutaneous endoscopic gas-trostomy/jejunostomy for enteral nutrition. The start time of enteral nutrition, indwelling time, complications caused by feeding tube and liver transplantation, and the average hospitalization time were recorded and compared.RESULTS： Compared with the nasogastric tube group, the start time of enteral nutrition in the gastric-jejunal tube group（25.7 d ± 5.2 d vs 97.3 d ± 9.6 d） was significantly earlier and the indwell-ing time was significantly longer（P〈0.01）. The incidence of gastroesophageal reflux and gastric retention in the gastric-jejunal tube group was significantly lower than that in the nasogastric tube group（10.00% vs 27.27%, 14.00% vs 34.09%, P〈0.05）. When the preoperative Meld score was greater than 15, the average hospitalization time was significantly shorter in the gastric-jejunal tube group than in the nasogastric tube group（P〈0.01）. CONCLUSION： The effects of enteral nutrition via a gastric-jejunal tube are significantly better than those via a nasogastric tube in patients after liver transplantation.

关 键 词：肝移植 肠内营养 鼻胃置管 经皮经胃空肠置管 

分 类 号：R657.3[医药卫生—外科学]