早期肠内营养对学龄前胆总管囊肿合并副肝管畸形患儿术后应激、免疫功能及预后的影响分析  

Effect of early enteral nutrition on stress,immune function and prognosis in preschool children with choledochal cyst and accessory hepatic duct malformation

作　　者：王磊 孟晓婉 曹慧 Wang Lei;Meng Xiaowan;Cao Hui(Department of General Surgery,Xuzhou Children's Hospital,Jiangsu,Xuzhou 221000,China)

机构地区：[1]徐州市儿童医院普外一科,江苏徐州221000

出　　处：《中国医学前沿杂志（电子版）》2020年第11期63-67,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：2019年江苏省医药卫生科技计划项目(J3269019)。

摘　　要：目的分析早期肠内营养对学龄前胆总管囊肿合并副肝管畸形患儿术后应激、免疫功能及预后的影响。方法选取徐州市儿童医院2015年1月至2019年10月收治的80例胆总管囊肿合并副肝管畸形患儿,使用随机数字表法将其分为观察组和对照组,每组各40例,两组患儿均行胆总管囊肿切除联合胆道重建、副肝管重建术治疗,对照组患儿术后给予全肠外营养,观察组患儿术后给予早期肠内营养。观察两组患儿围术期炎性反应、体液免疫、细胞免疫、肝功能变化以及术后恢复情况和不良反应发生情况。结果术后7 d,观察组患儿视黄醇结合蛋白(retinol-binding protein,RBP)水平显著低于术前(P<0.05),对照组患儿前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)、RBP水平均显著低于术前(均P<0.05),且观察组患儿PA、ALB、RBP水平均显著高于对照组(均P<0.05)。术后7 d,两组患儿C反应蛋白、白介素-6、白介素-8水平均显著高于本组术前(均P<0.05),且观察组患儿上述指标水平均显著低于对照组(均P<0.05)。观察组患儿术后7 d免疫球蛋白G、免疫球蛋白A、免疫球蛋白M及CD3+T细胞、CD4+T细胞、CD8+T细胞水平均显著高于对照组(均P<0.05)。术后7 d,两组患儿总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶水平均显著低于本组术前(均P<0.05),且观察组患儿上述指标水平均显著低于对照组(均P<0.05)。观察组患儿首次排便时间、拔除鼻胃管时间均显著短于对照组(均P<0.05),胃肠减压引流量显著少于对照组(P<0.05)。两组患儿不良反应发生率比较差异无统计学意义(P>0.05)。结论早期肠内营养能够缓解学龄前胆总管囊肿合并副肝管畸形患儿术后应激反应,改善免疫功能和肝功能,促进患儿术后恢复且安全性良好。Objective To analyze the effect of early enteral nutrition on stress,immune function and prognosis in preschool patients with choledochal cyst and accessory hepatic duct malformation.Method From January 2015 to October 2019,80 children with choledochal cyst and accessory hepatic duct malformation were selected and divided into observation group and control group by random number table method,40 cases in each group,who were treated with radical choledochal cyst resection and accessory hepatic duct reconstruction.Children in control group received total parenteral nutrition and children in observation group received early enteral nutrition.The changes of inflammatory reaction,humoral immunity,cellular immunity and liver function,and postoperative recovery,adverse reactions were observed in the two groups.Result At 7 days postoperatively,retinol-binding protein level in observation group was lower than that before operation(P<0.05),and the levels of prealbumin,albumin and retinol-binding protein in control group were lower than those before operation(all P<0.05),while the levels of prealbumin,albumin and retinol-binding protein in observation group were significantly higher than those in control group(all P<0.05).At 7 days postoperatively,the levels of C reactive protein,interleukin-6 and interleukin-8 in the two groups were higher than those before operation(all P<0.05),and those in observation group were significantly lower than those in control group(all P<0.05).At 7 days postoperatively,the levels of immunoglobulin G,immunoglobulin A,immunoglobulin M and CD3+T cell,CD4+T cell and CD8+T cell in observation group were significantly higher than those in control group(all P<0.05).At 7 days postoperatively,the levels of total bilirubin,direct bilirubin,alanine aminotransferase and aspartate aminotransferase in the two groups were significantly lower than those before operation(all P<0.05),and those in observation group were significantly lower than those in control group(all P<0.05).The first defecation time,extubati

关 键 词：肠内营养 胆总管囊肿 副肝管畸形 应激 免疫功能 

分 类 号：R726.5[医药卫生—儿科]