早期肠内营养支持在肝硬化食管胃底静脉曲张出血套扎术后患者中的应用  

Application of early enteral nutrition support in patients with hepatocirrhosis after ligation for esophagogastric variceal bleeding

作　　者：王戬 尹江宁 彭易根 张士卿 高俊 WANG Jian;YIN Jiangning;PENG Yigen(Department of Emergency,Nanjing Jiangning Hospital,Jiangsu,Nanjing 211100,China)

机构地区：[1]江苏省南京市江宁医院急诊科,211100

出　　处：《河北医药》2024年第23期3616-3619,共4页Hebei Medical Journal

基　　金：江苏卫生健康职业学院科研项目(编号:JKC202010);南京医科大学科技发展基金项目(编号:NMUB2019234)。

摘　　要：目的 探讨早期肠内营养支持对肝硬化食管胃底静脉曲张出血(EGVB)套扎术患者免疫功能及相关血清生化指标的影响。方法 选择2022年7月至2023年6月接受内镜套扎术治疗EGVH患者93例为研究对象,采用随机数字表法分为早期营养组(47例)和常规营养组(46例)。早期营养组于术后6 h给予肠内营养支持,常规营养组于术后24 h给予肠内营养支持。比较2组细胞免疫功能、营养学指标、肝功能、并发症。结果 术后2周,早期营养组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于常规营养组,CD8^(+)低于常规营养组(P<0.05);血清前白蛋白(PA)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)高于常规营养组(P<0.05);血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)低于常规营养组(P<0.05)。随访6周,早期营养组再次静脉曲张(6.38%)、再次出血(2.13%)、感染发生率(4.26%)低于常规营养组21.74%、13.04%、17.39%(χ^(2)=4.559、3.980、4.180,P<0.05)。结论 早期肠内营养支持能够改善EGVB套扎术患者细胞免疫功能,促进营养状况及肝功能恢复,预防术后再次出血等并发症的发生。Objective To investigate the effects of early enteral nutrition support on immune function and serum biochemical indexes in patients with esophagogastric variceal bleeding(EGVB)and cirrhosis for ligation.Methods A total of 93 EGVB patients who received endoscopic ligation from July 2022 to June 2023 were selected as the study subjects,and they were randomly divided into early nutrition group(47 cases)and conventional nutrition group(46 cases)by random number table method.The early nutrition group was given enteral nutrition support at 6h after surgery,and the conventional nutrition group was given enteral nutrition support at 24h after surgery.The cellular immune function,nutritional index,liver function and complications were compared between the two groups.Results Two weeks after operation,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in early nutrition group were significantly higher than those in conventional nutrition group,and CD8^(+)was significantly lower(P<0.05).Serum prealbumin(PA),transferrin(TRF)and retinol-binding protein(RBP)were significantly higher than those in conventional nutrition group(P<0.05).Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)were significantly lower than those in conventional nutrition group(P<0.05).After 6 weeks of follow-up,the incidence of recurrent varicose veins(6.38%),recurrent bleeding(2.13%)and infection(4.26%)in the early nutrition group was significantly lower than that in the conventional nutrition group(21.74%,13.04%,and 17.39%,respectively)(χ^(2)=4.559,3.980,and 4.180,respectively;P<0.05).Conclusion Early enteral nutrition support can improve cellular immune function,promote nutritional status and liver function recovery in EGVB patients treated with surgical ligation,and prevent postoperative complications such as rebleeding.

关 键 词：食管胃底静脉曲张出血 套扎术 早期肠内营养 免疫功能 营养学指标 

分 类 号：R657.31[医药卫生—外科学]