上消化道穿孔术后早期序贯性肠内营养支持的效果观察  

Effect of early sequential enteral nutrition support on patients with upper digestive tract perforation after surgery

作　　者：何承龙[1] 昝建宝[1] 宋康颉[1] 徐爱忠[1] 苗祥[1] HE Chenglong;ZAN Jianbao;SONG Kangjie;XU Aizhong;MIAO Xiang(Department of General Surgery,Anqing Hospital Affiliated to Anhui Medical University,Anqing 246000,Anhui Province,China)

机构地区：[1]安徽医科大学附属安庆医院普外科,安徽安庆246000

出　　处：《解放军医学院学报》2020年第9期901-904,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨上消化道穿孔术后早期序贯性肠内营养支持的疗效。方法选取安徽医科大学附属安庆医院普外科2017年1月-2019年4月收治的上消化道穿孔患者71例。将按随机数字表法分为两组,观察组36例,对照组35例。观察组术前留置液囊空肠营养管,术后经空肠营养管进行序贯性肠内营养支持治疗;对照组术前留置普通胃管,术后给予全肠外营养支持治疗。于术前和术后第7天检测两组患者的体质量指数、前白蛋白、血清白蛋白、术后肛门排气时间、体质量下降情况、住院时间、住院总费用及禁食期每日补液量。结果两组患者的性别、年龄、体质量指数及穿孔部位差异无统计学意义(P均>0.05)。术后第7天两组患者的各营养指标较术前均有所升高(P<0.05);观察组体质量指数、血清白蛋白及前白蛋白的升高幅度显著高于对照组(P<0.05)。两组患者术后肛门排气时间[(3.0±0.8) d vs (3.6±0.7) d]、术后住院时间[(5.2±2.3) d vs(7.3±2.6) d]、住院总费用[(12 905±2 723)元 vs (15 251±2 742)元]及禁食期补液量[(2 063±241) ml vs (2 224±264) ml]比较,观察组均明显低于对照组,差异有统计学意义(P均<0.05)。观察组并发症发生率低于对照组(22.2% vs 31.4%),但差异无统计学意义(P>0.05)。结论上消化道穿孔术后患者早期应用序贯性肠内营养支持能更好地改善营养状况,加速术后的康复。Objective To investigate the effect of early sequential enteral nutrition support after upper digestive tract perforation.Methods From January 2017 to April 2019,71 patients with upper digestive tract perforation admitted to the surgery department of the Anqing Hospital Affiliated to Anhui Medical University were selected.The patients were randomly divided into observation group (n=36) and control group (n=35) by the table of random number.Jejunal tube was placed before operation followed by sequential enteral nutrition therapy via jejunal tube in the observation group.In the control group,normal gastric tube was retained before operation and total parenteral nutrition support was given postoperatively.BMI,prealbumin,serum albumin,time to passing gas,loss of body weight,length of hospital stay,hospitalization expenses and volume of fluid replacement during fasting were measured preoperatively and at 7 days after operation.Results There was no significant difference in sex,age,body mass index and perforation site between the two groups (P>0.05).At 7 days after operation,the nutritional indexes of the two groups both significantly increased compared to the baseline,and the increases in body mass index,serum albumin and prealbumin in the observation group were significantly higher than those in the control group (all P<0.05).The time to passing gas ([3.0±0.8]d vs[3.6±0.7]d),postoperative length of hospital stay,([5.2±2.3]d vs[7.3±2.6]d),total hospitalization cost ([12 905±2 723]yuan vs[15 251±2 742]yuan) and volume of fluid replacement during fasting ([2 063±241]ml vs[2 224±264]ml) in the observation group were significantly lower than those in the control group (all P<0.05).The incidence of complications in the observation group was lower than that in the control group (22.2% vs 31.4%),but the difference was not significant (P>0.05).Conclusion Early application of sequential enteral nutrition support can improve the nutritional status of patients with upper digestive tract perforation after operation,and ac

关 键 词：上消化道穿孔 序贯性肠内营养 加速康复外科 外科营养 血清白蛋白 

分 类 号：R619[医药卫生—外科学] R639[医药卫生—临床医学]