围手术期肠内、外营养治疗在肝切除术后患者快速康复中的作用  

Effect of perioperative enteral and parenteral nutrition on rapid recovery of patients after hepatectomy

作　　者：陈莹[1] 张雅敏[2] CHEN Ying;ZHANG Ya-min(Department of General Surgery,Tianjin Occupational Disease Prevention and Control Hospital(Workers′Hospital),Tianjin 300011,China;Department of Hepatobiliary Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市职业病防治院(工人医院)普通外科,天津300011 [2]天津市第一中心医院肝胆外科,天津300192

出　　处：《天津医科大学学报》2021年第4期384-387,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨新型橄榄油脂肪乳肠外营养联合肠内营养对肝切除术后恢复的作用。方法:收集2018年12月—2020年2月天津市第一中心医院拟行肝切除的肝细胞癌患者48例。随机分为试验组(n=24)和对照组(n=24)。试验组术前3 d给予口服肠内营养混悬剂TP-MCT,术后前3 d静脉输入新型橄榄油脂肪乳联合术后早期给予肠内营养混悬剂TP-MCT;对照组术前给予自由肠内营养,术后前3 d静脉输入大豆油长链脂肪乳的配制型肠外营养液联合术后早期给予口服肠内营养混悬剂TP-MCT。比较两组术前一般指标,术后并发症、营养状况、肝功能、体液、细胞免疫及炎症因子水平改变。结果:试验组和对照组在恶心呕吐、腹泻及术后并发症总发生率上的差异有统计学意义(χ^(2)=3.122、4.415、4.761,均P<0.05)。试验组术后7 d体重指数(BMI)和皮脂厚度均高于对照组(t=2.860,P<0.05);术后第3天和第7天,试验组血清白蛋白水平及前白蛋白明显高于对照组(t=3.652、4.150,均P<0.05)。试验组与对照组术后第1天乳酸脱氢酶(LDH)、直接胆红素(DBIL)、活化部分凝血酶原时间(APTT)存在差异性(t=2.312、3.165、4.178,均P<0.05);术后第3天及第7天,谷草转氨酶(AST)、谷丙转氨酶(ALT)、LDH、DBIL、间接胆红素(IBIL)、APPT(t=1.450~6.152,均P<0.05)。术后第3天CD4^(+)、CD8^(+)T细胞在试验组中比例下降低于对照组(χ^(2)=5.750,P<0.05)。结论:应用新型橄榄油脂肪乳肠外营养联合肠内营养减少术后并发症的发生,耐受性良好,有助于营养状况、肝功能指标、细胞免疫、体液免疫及炎症因子水平的恢复。Objective:To investigate the effect of new olive oil fat emulsion parenteral nutrition combined with enteral nutrition on the recovery after hepatectomy.Methods:A total of 48 patients with hepatocellular carcinoma who were admitted to Tianjin First Central Hospital from December 2018 to February 2020 for hepatectomy were collected.They were randomly divided into experimental group(n=24)and control group(n=24).The experimental group was given oral enteral nutrition suspension TP-MCT 3 days before operation,intravenous injection of new olive oil fat emulsion combined with early postoperative enteral nutrition suspension TP-MCT 3 days after operation;the control group was given free enteral nutrition before operation,intravenous injection of soybean oil long chain fat emulsion combined with early postoperative oral enteral nutrition suspension TP-MCT 3 days before operation.The general indexes,postoperative complications,nutritional status,liver function,humoral and cellular immunity and inflammatory factors were compared between the two groups.Results:There were significant differences in the incidence of nausea,vomiting,diarrhea and postoperative complications between the experimental group and the control group(χ^(2)=3.122,4.415,4.761,all P<0.05).The body mass index(BMI)and sebum thickness of the experimental group were higher than those of the control group on the 7th day after operation(t=2.860,P<0.05);the serum albumin level and prealbumin of the experimental group were significantly higher than those of the control group on the 3rd and 7th day after operation(t=3.65,24.150,both P<0.05).There were significant differences in LDH,DBIL and APTT between the experimental group and the control group on the first day after operation(t=2.312,3.165,4.178,all P<0.05);there were significant differences in AST,ALT,LDH,DBIL,IBIL and APTT on the third and seventh day after operation(t=1.450-6.152,all P<0.05).On the third day after operation,the proportion of CD4^(+) and CD8^(+)T cells in the experimental group was lower th

关 键 词：肝癌 肝切除术 肠内营养 肠外营养 围手术期 肝功能 

分 类 号：R657.3[医药卫生—外科学]