肠内营养对脾切除加门奇静脉断流术后门静脉血栓形成的影响  

The impact of enteral nutrition on the development of portal vein thrombosis after esophagogastric devascularization and splenectomy

作　　者：陈焰[1] 张明[1] 丁闯[1] 孔令永[1] 刘丛斌 Chen Yan;Zhang Ming;Ding Chuang;Kong Lingyong;Liu Congbin(Department of Genral Surgery,Suqian People＇s Hospital of Nanjing Drum-Tower Hospital Group,Suqian 223800,Jiangsu Provincial,China)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院普外科,223800 [2]南京鼓楼医院集团宿迁市人民医院影像科,223800

出　　处：《中华肝胆外科杂志》2018年第9期585-589,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的观察脾切除加门奇静脉断流术（EDS）后患者早期肠内营养（EN）对门静脉血液动力学变化及其血栓形成的影响。方法将我院2015年1月至2017年1月行EDS的93例患者随机分为两组。研究组（n=48）术中将鼻肠营养管放至十二指肠空肠曲下方20cm处，术后6小时经此鼻肠管进行肠内营养。对照组术后予以全胃肠外营养（PN）。通过彩色多普勒监控术前、术后以及肠内营养不同滴速情况下门静脉主干内径、血流速度、血流量的变化，及其与门静脉血栓形成的关系，并与对照组（n=45）进行比较。结果研究组术后EN前门静脉最大流速由术前的（25．9±5．6）cm／s降至（16.8±5．0）cm／s，差异有统计学意义（P〈0．01）；术后门静脉平均流速由术前的（20．6±4．6）cm／s降至（14．8±4．2）cm／s，差异亦有统计学意义（P〈0．01）。随着EN滴速和量的增加，门静脉平均血流速度逐渐加快、血流量明显增加，尤其是第三天泵入康全甘后，与对照组比较，差异有统计学意义（P〈0．01）。分析显示研究组门静脉主干内径较对照组增宽，差异有统计学意义（P〈0．01）。术后门静脉血栓形成发生率，研究组（2／48，4．0％）较对照组（9／45，20．0％）明显降低，差异有统计学意义（均P〈0．05）。结论EDS后早期EN不仅可为患者提供足够的营养，还可通过促进门静脉血流量减少门静脉血栓的发生，促进肝脏的功能恢复。Objective To investigate the change of the hemodynamics of the portal vein and the impact on portal vein thrombosis after esophagogastric devascularization and splenectomy （EDS） with early enteral nutrition. The impact of early enteral nutrition on portal vein thrombosis was studied. Methods 93 patients who underwent EDS in our hospital from January 2017 to January 2015 were randomly assigned to the control group and the study group. In the study group, a nasogastric tube was placed 20 cm into the duodenum-jejunum region. Enteral nutrition was administered via the nasogastric tube 6 hours after the operation. The patients in control group were treated with total parenteral nutriction after the operation. The changes in the diameter of the portal vein, the blood flow velocity and the blood flow of the portal vein were monitored by color Doppler before and after the operation. The relationships of these measurements with formation of portal vein thrombosis were compared with the control group. Results In the enteral nutrition study group, the maximum velocity of the portal vein blood flow decreased from （25.9±5.6） cm/s before operation to （16.8±5.0） cm/s after operation, and the difference was statistically significant （P〈0.01）. The average velocity of portal vein blood flow decreased from （20.6±4.6） cm/s to （14.8±4.2） cm/s after operation, and the difference was also statistically significant （P〈0.01）. With the increase in enteral nutrition speed and volume, the average blood flow velocity of the portal vein and the blood flow increased significantly, especially after the third day with the use of Kang Quan Gan, and the difference was statistically significant compared with the control group （P〈0.01）. The diameter of the trunk of the portal vein in the study group was wider than that in the control group, and the difference was statistically significant （P〈0.01）. The incidences of portal vein thrombosis in two groups were compared. The results showed that the inciden

关 键 词：脾切除加门奇静脉断流术(EDS) 肠内营养(EN) 门静脉血栓(PVT) 

分 类 号：R657.6[医药卫生—外科学] R459.3[医药卫生—临床医学]