肝移植术后早期肠内营养降低终末期肝病患者移植术后感染发生率的研究  

Early enteral nutrition after liver transplantation reducing the incidence of postoperative infection in patients with end-stage liver disease

作　　者：范明明[1] 赵辉[1] 傅斌生[1] 安玉玲[1] 易小猛[1] 刘剑戎[1] 易慧敏[1] 

机构地区：[1]中山大学附属第三医院外科ICU,广州510080

出　　处：《中华普通外科学文献（电子版）》2015年第6期446-450,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省自然科学基金(S2013010016785);广州市科技计划项目(2011Y1-00033-1)

摘　　要：目的探讨肝移植术后早期肠内营养对患者感染发生率的影响。方法收集2012年6月至2015年1月于本中心行肝移植手术的全部病例,进行前瞻性队列研究。共有177例患者参与研究,其中60例在术后24 h内开展肠内营养,辅以肠外营养(试验组);117例早期予以全肠外营养,直至患者肛门排气后开始肠内营养(对照组)。根据患者术前的MELD评分进行分级,观察早期肠内营养对不同MELD评分的患者肝移植术后感染的影响。结果 177例患者中共有106例(59.9%)发生术后感染。性别、MELD评分与早期肠内营养3个变量为影响总感染率的独立危险因素(P=0.027、0.045、0.000)。早期肠内营养可以降低11≤MELD评分≤20患者的术后感染发生率(P=0.014)。随着MELD评分增加,早期肠内营养对感染发生率的影响逐渐缩小。结论早期肠内营养可降低中度终末期肝病患者肝移植术后感染发生率。Objective To explore the influences of early enteral nutrition(EN) in the incidence of postoperative infection for patients after liver transplantation. Methods All the liver transplant patients between June 2012 and January 2015 in our center were collected in a prospective cohort study.This study enrolled 177 patients, including 60 patients in early enteral group who started initial enteral nutrition within 24 hours after surgery, and 117 patients who started with total parenteral nutrition(TPN) and did not start EN until anus exhaustion or defecation. Patients were classified according to the Model for End Stage Liver Disease(MELD)score. The effect of early enteral nutrition at different levels were analyzed to view whether the effect in patients with different levels was selective. Results One hundred and six cases(59.9%) were reported postoperative infection. Gender, MELD score and early enteral nutrition were independent risk factors affecting total infection rate(P=0.027, 0.045, 0.000). Early enteral nutrition reduced the infection rate in less severe patients, especially in patients whose MELD score was between11-20(P=0.014). With the increase of MELD score, the influence of early enteral nutrition on infection rates gradually narrowed. Conclusion Early enteral nutrition can significantly reduce the incidence of infection in patients with medium MELD score after transplantation.

关 键 词：肝移植 肠道营养 术后 感染 

分 类 号：R657.3[医药卫生—外科学]