早期肠内生态免疫营养对老年腹部术后病人的影响  

Effect of early enteral eco-immunonutrition therapy on elder patients undergoing abdominal operation

作　　者：张剑琴 杨刚华[2] 孟凡迪[2] 万永[2] 盛斌武[2] ZHANG Jianqin;YANG Ganghua;MENG Fandi;WAN Yong;SHENG Binwu(Department of Clinical Nutrition,The Fourth People’s Hospital of Shaanxi Province,Xi’an,Shaanxi 710043,China;Department of Geriatric Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an,Shaanxi 710061,China)

机构地区：[1]陕西省第四人民医院临床营养科,陕西西安710043 [2]西安交通大学第一附属医院老年外科,陕西西安710061

出　　处：《安徽医药》2019年第10期2036-2040,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨早期肠内生态免疫营养治疗对老年腹部术后病人全身营养状态、术后并发症发生率及免疫功能的影响。方法按纳入标准共选择2016年1月至2017年12月在西安交通大学第一附属医院老年外科行腹部手术的老年病人85例,其中行胰十二指肠切除术36例,胃空肠吻合术25例,胃癌根治术11例,结肠癌根治术6例,其他手术7例。通过Excel自带程序随机分组法分为研究组和对照组。研究组40例,对照组45例。研究组于术后第1天开始启动个性化肠内生态免疫营养治疗,对照组传统常规肠内营养处理。两组均查术前、术后3、7、14 d血清白蛋白、前白蛋白、尿素、肌酐、血红蛋白及淋巴细胞计数(比例),观察术后通气时间、白蛋白使用量、住院时间、药占比。分析两组之间术后并发症、上述指标差异及治疗与术后并发症相关因素。结果研究组发生术后并发症3例(7.5%),对照组14例(31.1%),两者差异有统计学意义(χ^2=7.378,P=0.007),logistic多因素相关分析提示术后并发症发生与治疗呈负相关(OR=0.212,95%CI:0.055~0.809,P=0.023)。术后3 d研究组尿素氮水平低于对照组(P=0.016);研究组血清前白蛋白水平在术后3 d、7 d、14 d均高于对照组(分别为P=0.023,0.019,<0.001);术后3 d、14 d研究组淋巴细胞计数高于对照组(分别为P=0.026,P<0.001),且14 d研究组淋巴细胞比例高于对照组(P<0.001);术后3 d、14 d研究组血红蛋白水平高于对照组(分别为P=0.006;P<0.001);研究组病人术后通气时间早于对照组(P<0.001),白蛋白使用量少于对照组(P=0.013),住院时间短于对照组(P=0.027);药占比两组之间差异无统计学意义(P=0.406)。结论给予老年腹部术后病人早期肠内生态免疫营养可显著改善病人营养状况,降低并发症的发生,提高机体免疫功能。Objective To investigate the effects of early enteral eco?immunonutrition therapy on the nutritional status,postoperative complications and immune function of the elderly patients undergoing abdominal operation.Methods Eighty?five elderly patients undergoing the abdominal operation in The First Affiliated Hospital of Xi’an Jiaotong University from January 2016 to December 2017 were selected according to the inclusion criteria,,including 36 cases undergoing pancreaticoduodenectomy,25 cases of gastro?jejunostomy,11 cases of radical gastrectomy,6 cases of colon cancer radical surgery,and 7 cases of other operations.Patients were assigned into study group(40 cases)and control group(45 cases)randomly by the method of random grouping of excel own?band program.The patients in study group were given enteral nutrition on the first day after operation,and were gradually given individu?alized enteral ecological immune nutrition preparation.The patients in control group were given enteral nutrition routinely.Serum al?bumin,pre albumin,urea,creatinine,hemoglobin and lymphocyte count(ratio)were checked before operation and on 3 d,7 d,14 d after operation.Duration of ventilation,albumin usage,length of stay,and the percentage of drug expenditure after operation were ob?served in the two groups.The postoperative complications,the differences of the above indicators and the related factors of treatment and postoperative complications were analyzed.Results Postoperative complications in the study group(3 cases,7.5%)were statis?tically lower than that in the control group(14 cases,31.1%)(χ^2=7.378,P=0.007);logistic regression showed that there was sta?tistically negative correlation between the postoperative complications and treatment(OR=0.212,95%CI:0.055?0.809,P=0.023).The level of urea nitrogen in the study group was lower than that in the control group at 3 days after operation(P=0.016).Serum pre albumin levels in the study group were statistically higher than in the control group at d3,d7 and d14 after operation(P=0.023,0.0

关 键 词：肠道营养 消化系统外科手术 前白蛋白 淋巴细胞计数 肠内生态免疫营养 老年人 

分 类 号：R47[医药卫生—护理学]