Whipple术中留置空肠营养管的临床意义  

Clinical significance of setting nasojejunal nutrition tube in Whipple operation

作　　者：贾世峰[1] 闫丰[1] 张学鹏[1] 朱红成[1] 焦桂梅[1] 刘博[2] 

机构地区：[1]河北联合大学附属医院肿瘤科,河北省唐山市063000 [2]解放军总医院肝胆外科

出　　处：《中国综合临床》2014年第10期1049-1052,共4页Clinical Medicine of China

摘　　要：目的 探讨Whipple术中留置空肠营养管促进患者恢复及防治并发症的临床意义.方法 将41例行Whipple手术患者随机分为两组,空肠内营养组（EN组）和肠外营养组（PN组）.EN组术中置空肠营养管,术后早期予以肠内营养;PN组术后早期经静脉予以营养支持.对比两组患者的手术时间、术后并发症、住院费用、住院时间、营养状况等指标的差异.结果 EN组与PN组手术时间分别为（200.71±51.33） min与（160.48±47.62） min,两组比较差异无统计学意义（t=-1.524,P＞0.05）;住院费用分别为（38 835.65±537.69）元与（47 833.18±659.24）元（t=2.073,P＜0.05）,住院时间分别为10（3）、18（3） d（Z=-5.374,P＜0.001）,两组比较差异均有统计学意义.EN组有2例患者发生术后并发症,其中切口感染1例,胰瘘1例;PN组9例,切口感染3例、胰瘘2例、肺部感染2例、胃瘫2例,均经保守治疗后痊愈.两组术后并发症发生率比较差异有统计学意义（P =0.027）.EN组与PN组患者术后第7天血红蛋白分别为（113.09±12.35） g/L与（107.04±11.81） g/L（t=2.035,P＜0.05）,视黄醇结合蛋白分别为（42.62±5.64） mg/L与（15.50±4.26） mg/L（t=2.398,P＜0.05）,血清白蛋白分别为（40.24±6.79） g/L与（31.52±5.92） g/L（t=2.606,P＜0.01）,血清前白蛋白分别为（321.43±31.28）mg/L与（197.86±37.71） mg/L（t =2.119,P＜0.05）,血清转铁蛋白分别为（32.86±4.67） mg/L与（23.59±4.32） mg/L（t =2.569,P＜0.05）.结论 术中留置空肠营养管可明显改善Whipple术后患者的营养状态和预后,并减少住院时间和住院费用.Objective To investigate the clinical significance of setting nasojejunal nutrition tube in Whipple operation,which can promote patient recovery and prevent complications.Methods Fourty-one patients were undergone Whipple operation and they were randomly divided into eternal nutrition （EN） and parenteral nutrition group （PN）.Patients in EN group were set nasojejunal nutrition tube during Whipple operation in order to supply eternal nutrition at earlier period,while in PN group were supplied parenteral nutrition in earlier period.The operative procedure time,the complication in post-operation,the cost of hospitalization and the periods of hospitalization of two groups were recorded.The scores of nutritional status were measured.Results The operative time in EN group and PN group were （200.71 ±51.33）min and （160.48 ± 47.62） min,and no significant difference was found between two groups （t =-1.524,P 〉 0.05）.The hospitalization expenses in EN group was （38835.65 ± 537.69）yuan,lower than that in PN group （（47833.18 ±659.24） yuan,t =2.073,P 〈 0.05）.The hospital periods of EN group and PN group were 10 （3） d and 18（3） d,and the difference was significant （Z =-5.374,P 〈0.001）.There were 2 cases who occurred complications after operation in EN group,including 1 cases with incision infection,and 1 cases of pancreatic fistula.Nine cases occurred complications in PN group,including 3 cases with incision infection,2 cases with pancreatic fistula,2 cases with pulmonary infection,2 cases with gastric paralysis,and all were cured by conservative treatment.There was statistically significant difference in the incidence of postoperative complications （P =0.027）.All cases with complication were recovery after corresponding treatment.At 7th day after operation,hemoglobin in EN group and PN group were （113.09 ± 12.35） g/L and （107.04 ± 11.81） g/L,and the difference was significant （t =2.035,P 〈 0.05）.The levels of retinol binding protein,serumalbumin,serum prea

关 键 词：空肠营养管 WHIPPLE术 肠内营养 

分 类 号：R656[医药卫生—外科学]