肝切除术中应用甲基强的松龙联合围手术期肠内营养对术后康复的作用  

Effect of intraoperative methylprednisolone in combination with perioperative enteral nutrition support on recovery after hepatectomy

作　　者：訾雪剑 姚辉[2] 仇毓东[2] 伏晓[2] 毛谅[2] 周铁[2] 陈超波[2] 

机构地区：[1]南京医科大学鼓楼临床医学院,210000 [2]南京大学医学院附属鼓楼医院肝胆胰外科

出　　处：《中华临床营养杂志》2015年第2期89-94,共6页Chinese Journal of Clinical Nutrition

基　　金：江苏省卫生厅医学重点人才项目（RC2011003）

摘　　要：目的评估肝切除术中单剂应用甲基强的松龙联合围手术期肠内营养对术后肝脏合成功能的影响，以及对术后恢复的作用。方法采用前瞻性对照研究方法，选取2013年6月至2014年5月在南京鼓楼医院肝胆胰外科行肝切除术的79例患者，按照手术顺序交替入组，分为对照组39例、研究组40例。研究组在肝切除开始时单剂静脉应用甲基强的松龙500mg，两组患者围手术期均采用相同的肠内营养支持方案。检测术前和术后第1、3、5天血液肝功能指标、前白蛋白以及C反应蛋白，记录术后外源性人血白蛋白总输注量、术后首次肛门排气时间、术后住院时间和术后并发症发生情况。结果与对照组比较，研究组术后第3天血清前白蛋白显著升高[（101．26±61．17）mg／L比（81．84±43．58）mg／L，t=-1．607，P=0．049]；术后第1天血清胆碱酯酶显著升高[（5．60±1．54）kU／L比（4．68±1．01）kU／L，t=-3．136，P=0．004]；术后第1、3天血清C反应蛋白显著降低[（41．79±20．86）mg／L比（62．08±38．33）mg／L，t=2．933，P=0．027；（64．14±32．38）mg／L比（102．64±49．05）mg／L，t=4．127，P=0．006]。与对照组比较，研究组术后住院时间显著缩短[（12．62±5．74）d比（15．41±10．00）d，t=1．514，P=0．002]。结论肝切除术中单剂应用甲基强的松龙可抑制术后炎症反应，与围手术期肠内营养联合应用可促进术后肝脏合成功能的恢复，有助于促进患者康复。Objective To investigate the clinical efficacy of intraoperative methylprednisolone used in combination with perioperative enteral nutrition support in improving liver synthetic function after hepatectomy and postoperative recovery. Methods In this prospective controlled trial, 79 patients treated with hepatecto- my at Departement of Hepatobiliary Pancreatic Surgery in Drum Tower Hospital between June 2013 and May 2014 were included and divided into control group （n = 39） and steroid group （n = 40） according to the or- der of surgery. The control group underwent hepatectomy only, while the steroid group received intraoperative methylprednisolone （500 mg） at the start of liver excision. Both of the two groups were given the same perio- perative enteral nutrition support. Liver function, prealbumin （PA） , and C-reactive protein （CRP） levelswere measured before and on days 1 , 3, and 5 after the operation. Human blood albumin infusion volume, postoperative gas passing, postoperative hospital stay, and incidence of complications were recorded. Results The serum level of PA on day 3 after hepatectomy was significantly higher in the steroid group than in the control group [ （ 101.26 ±61.17） mg,/L vs. （81.84 ±43.58） mg/L, t = - 1. 607, P =0. 049]. The ser- um level of cholinesterase on day 1 after hepatectomy was significantly higher in the steroid group than in the control group [ （5.60±1.54） kU/Lvs. （4. 68±1.01） kU/L, t= -3.136, P=0.004]. On dayl and day 3 after hepatectomy, the serum levels of CRP were significantly lower in the steroid group than in the con- trol group [ （41.79 ±20.86） mg/L vs. （62.08 ±38.33） rag/L, t =2.933, P=0.027; （64.14 ± 32.38） mg/L vs. （ 102.64 ±49.05） mg/L, t = 4. 127, P = 0. 006 ]. The postoperative hospital stay was significantly shorter in the steroid group than in the control group [ （ 12. 62 ±5.74） d vs. （ 15.41 ± 10. 00） d, t = 1.514, P = 0. 002 ]. Conclusion Intraoperative use of methylprednisolone combined with pe

关 键 词：肝切除术 甲基强的松龙 肠内营养 肝功能 

分 类 号：R657.3[医药卫生—外科学] R459.3[医药卫生—临床医学]