行微创经皮肾穿刺激光碎石术后慢性出血的高龄患者中部分肠外营养支持作用评价  

Partial parenteral nutrition support in elderly patients with chronic hemorrhage after minimally invasive percutaneous nephrolithotomy

作　　者：李鹏[1] 杨荣华[1] 张明华[1] Peng Li;Rong-Hua Yang;Ming-Hua Zhang(Department of Urology,Huzhou Central Hospital,Huzhou 313000,Zhejiang Province,China)

机构地区：[1]湖州市中心医院泌尿外科,浙江省湖州市313000

出　　处：《世界华人消化杂志》2019年第5期318-323,共6页World Chinese Journal of Digestology

摘　　要：背景慢性出血是微创经皮肾穿刺激光碎石术(percutaneous nephrolithotomy, PCNL)后常见的并发症,在高龄患者中的发生率较高,影响患者的术后康复.术后3 d后的出血多与手术创面愈合差、凝血痂脱落及感染等相关.我们推测通过给予部分肠外营养的支持方案能够改善患者的营养状态,进而达到治疗慢性出血的目的 .目的探讨在行PCNL后慢性出血的高龄患者中部分肠外营养支持方案,对其营养状态、促进其快速康复的影响.方法选择的研究对象为在2013-08/2017-08期间,湖州市中心医院收治的行PCNL后慢性出血的高龄患者,根据营养支持方案的不同分为给予部分肠外营养联合普通肠内营养的病例组,共60例患者,和单纯给予普通肠内营养的对照组,共70例患者.然后将两组患者的血红蛋白、球蛋白、前白蛋白、转铁蛋白等营养指标,出血停止时间、术后住院时间、停止静脉输液时间及介入栓塞率等恢复指标进行比较.结果在治疗后,病例组患者的血红蛋白、球蛋白、前白蛋白、转铁蛋白、视黄醇结合蛋白分别为113.19±3.31、32.68±2.66、0.41±0.08、2.67±0.13、0.85±0.13,明显高于对照组的106.82±1.91、28.22±2.58、0.25±0.06、2.19±0.06、0.63±0.12,差异均具有统计学意义(P<0.05);病例组患者的出血停止时间、术后住院时间、停止静脉输液时间、介入栓塞率分别为46.12±9.82、8.31±2.25、6.58±1.68、8.33%,明显低于对照组的73.36±10.17、15.25±3.21、13.31±2.11、22.85%,差异具有统计学意义(P <0.05).结论在行PCNL后慢性出血的高龄患者中,应用部分肠外营养的支持方案,能够改善患者的营养状态,促进出血停止,促进患者的快速康复.BACKGROUND Chronic hemorrhage is a common complication after minimally invasive percutaneous nephrolithotomy(PCNL)with laser lithotripsy.It has a high incidence in elderly patients and affects postoperative rehabilitation.Bleeding occurring after 3 d of surgery is associated with poor healing of surgical wounds,sloughing of clotting,and infection.We hypothesized that partial parenteral nutrition support can improve the nutritional status of patients and help achieve the goal of controlling chronic bleeding.AIM To investigate the effects of partial parenteral nutrition support on the nutritional status and recovery of elderly patients with chronic hemorrhage after minimally invasive PCNL with laser lithotripsy.METHODS The selected subjects were elderly patients with chronic hemorrhage who underwent minimally invasive PCNL at in Huzhou Central Hospital from August 2013 to August 2017.According to different nutritional support programs,they were divided into an observation group,which was given partial parenteral nutrition combined with common enteral nutrition treatment(60 patients),and a control group,which was given common enteral nutrition treatment alone(70 patients).Nutritional indicators such as hemoglobin,globulin,prealbumin,and transferrin in the two groups were compared,and recovery indexes such as time to hemostasis,postoperative hospital stay,time to discontinuing intravenous infusion,and interventional embolization rate were compared.RESULTS After treatment,hemoglobin,globulin,prealbumin,transferrin,and retinol binding protein in the observation group were significantly higher than those in the control group(13.19±3.31 vs 106.82±1.91,32.68±2.66 vs 28.22±2.58,0.41±0.08 vs 0.25±0.06,2.67±0.13 vs 2.19±0.06,0.85±0.13 vs 0.63±0.12;P<0.05).Time to hemostasis,postoperative hospital stay,time to discontinuing intravenous infusion,and interventional embolization rate in observation group were significantly lower than those in the control group(46.12±9.82 vs 73.36±10.17,8.31±2.25 vs 15.25±3.21,6.58�

关 键 词：激光碎石 术后 出血 肠外营养 快速康复 

分 类 号：R699[医药卫生—泌尿科学]