根治性胰十二指肠切除术后肠内营养的时机探讨  

Timing of enteral nutrition in patients with pancreatoduodenectomy

作　　者：储霞飞 黄强 袁丽[2] 谢放 胡传来[1] CHU Xiafei;HUANG Qiang;YUAN Li(School of Public Health,Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学公共卫生学院,合肥230032 [2]中国科学技术大学附属第一医院(安徽省立医院)胆胰外科,合肥230001

出　　处：《安徽医学》2020年第11期1261-1264,共4页Anhui Medical Journal

基　　金：安徽省科技攻关项目(项目编号:1804h08020277)。

摘　　要：目的探讨根治性胰十二指肠切除术(PD)患者术后肠内营养给予的最佳时机。方法回顾性分析中国科学技术大学附属第一医院(安徽省立医院)2019年5月至2020年4月行PD的86例患者临床资料。按照行肠内营养开始的时间,分为<24 h组(术后24 h内给予肠内营养)、24 h~组(术后24~48 h内给予肠内营养)及48 h~组(术后48 h后开始肠内营养),比较术前、术后第3天和第7天各组血红蛋白、白蛋白、前白蛋白水平及胃肠功能恢复和并发症发生情况。结果3组患者不同时间点白蛋白、前白蛋白水平比较差异有统计学意义(P<0.05);术前3组患者营养指标比较,差异无统计学意义(P>0.05),术后第3、7天患者白蛋白、前白蛋白水平先下降后上升,且≤24 h组患者术后第3天和第7天白蛋白、前白蛋白水平均高于其他组(P<0.05)。<24 h组术后肛门排气时间、首次下床时间短于24 h~组及48 h~组,差异均有统计学意义(P<0.05);各组胰瘘、胆漏、胃排空延迟、腹腔出血及肠内营养不耐受发生率比较,差异均无统计学意义(P>0.05)。结论PD术后最佳肠内营养时间为术后24h内给予。Objective To explore the timing of enteral nutrition in patients with pancreaticoduodenectomy.Methods A retrospective analysis was performedon the clinical data of 86 patients undergoing pancreaticoduodenectomy(PD)in the First Affiliated Hospital of USTC from May 2019 to April 2020.According to the start time of enteral nutrition,patients were divided into≤24 h(24 hours after operation),24 h^(24^48 h after operation),and 48 h^(>48 h after operation)groups.The level of hemoglobin,albumin,prealbumin and gastrointestinal function recovery in each group were observed.Results The differences in albumin and prealbumin levels among three groups at different stages were statistically significant(P<0.05);the nutritional indexes of the three groups before operation were not statistically significant(P>0.05).The albumin and prealbumin levels at 3 days and 7 days after operation decreased first and then increased,and the levels of albumin and prealbumin at 3 and 7 days after operation in≤24 h,were significantly higher than those in 24 h^and 48 h^enteral nutrition group(P<0.05).The exhaust time and the leaving bed time in≤24 h enteral nutrition support group were significantly lower than those in 24 h^and 48 h^enteral nutrition group(P<0.05),and the incidence of comorbid disorders(pancreatic fistula/bile leakage/delayed gastric emptying)and enter nutrition intolerance in each group was not statistically significant(P>0.05).Conclusion The optimal enteral nutrition time after PD is within 24 hour after operation.

关 键 词：肠内营养 胰十二指肠切除术 术后康复 

分 类 号：R657.5[医药卫生—外科学] R459.3[医药卫生—临床医学]