早期肠内营养结合肠外营养对胰十二指肠切除术后患者的影响  

Effect of early enteral nutrition combined with parenteral nutrition on patients after pancreaticoduodenectomy

作　　者：潘军平[1] 吴亚夫[1] 朱新华[1] PAN Jun-ping;WU Ya-fu;ZHU Xin-hua(Department of Hepatobiliary Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,江苏南京210008

出　　处：《中国临床研究》2023年第2期176-181,共6页Chinese Journal of Clinical Research

基　　金：江苏省“六大人才高峰”高层次人才资助项目(2016-WSW-067)。

摘　　要：目的探讨早期肠内营养联合肠外营养支持对胰十二指肠切除术患者的影响。方法回顾性分析2012年1月至2018年11月在南京鼓楼医院行胰十二指肠切除的患者222例,根据营养方式不同分为早期肠内营养联合肠外营养组(EEN+PN组,n=141)和全肠外营养组(TPN组,n=81)。比较两组术前1 d和术后第6天的营养相关指标和肝功能,术后并发症及住院时间。结果与TPN组相比,EEN+PN组前白蛋白(PAB)下降差值更大,差异有统计学意义(P<0.05);EEN+PN组总胆红素(TB)、直接胆红素(DB)在术后第6天显著降低(P<0.01);EEN+PN组术后住院时间明显缩短(P<0.05);EEN+PN组感染并发症较TPN组降低(41.8%vs 65.4%,P<0.05)。EEN+PN组胃排空延迟率和高血糖率低于TPN组(P<0.05)。结论早期肠内营养联合肠外营养可显著改善患者术后肝功能,减少感染和胃排空延迟,缩短术后住院时间。Objective To investigate the effect of early enteral nutrition combined with parenteral nutrition on patients received pancreaticoduodenectomy.Methods A retrospective analysis of 222 patients who underwent pancreaticoduodenectomy at Nanjing Drum Tower Hospital from January 2012 to November 2018 was conducted.According to different feeding methods,patients were divided into two groups:early enteral nutrition combined with parenteral nutrition group(EEN+PN group,n=141)and total parenteral nutrition group(TPN group,n=81).The nutritional indicator,liver function at 1 day before operation and 6 days after operation,postoperative complications and hospital stay were compared between the two groups.Results Compared with TPN group,the decrease difference of prealbumin(PAB)in EEN+PN group was statistically significant(P<0.05).Total bilirubin(TB)and direct bilirubin(DB)in EEN+PN group decreased significantly on the 6th day after operation(P<0.01).The hospital stay in EEN+PN group was significantly shortened(P<0.05).The infection complications in EEN+PN group were less than those in TPN group(41.8%vs 65.4%,P<0.05).The delayed gastric emptying rate and hyperglycemia rate in EEN+PN group were lower than those in TPN group(P<0.05).Conclusion Early enteral nutrition combined with parenteral nutrition can significantly improve the liver function of patients after operation,reduce infection and delayed gastric emptying,and shorten the postoperative hospital stay.

关 键 词：胰十二指肠切除术 肠内营养 肠外营养 并发症 前白蛋白 总胆红素 直接胆红素 胃排空延迟 

分 类 号：R73[医药卫生—肿瘤]