老年患者胰十二指肠切除术后不同营养支持方法对肝功能和临床结局的影响

目的比较胰十二指肠切除术后老年患者肠外营养（PN）联合肠内营养（EN）与单纯PN对术后内毒素血症、肝功能与临床结局的影响。方法回顾性总结我院不同时段接受胰十二指肠切除术老年患者共48例，其中术后接受PN联合EN营养支持的患者25例为研究组（PN＋EN组），单纯给予PN营养支持的患者23例为对照组（PN组）。记录其一般资料、比较术后内毒素水平和肝功能变化，以及临床结局（死亡率、并发症、术后住院日和总住院费用等）。结果两组内毒素水平术后1d较术前均有升高趋势，但组间比较差异无统计学意义（P〉0．05），后随时间逐渐下降，其中术后7和14d分别与术后1d的差值比较，PN＋EN组的下降幅度显著大于PN组（P〈0．01）；两组谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素值术后1d较术前均有升高趋势，但组间比较差异无统计学意义（P〉0．05），术后逐渐下降，术后14d与术后1d的差值PN＋EN组下降幅度显著高于PN组（P〈0．05）；PN＋EN组感染并发症（2／25，8．0％）显著低于PN组（6／23，26．0％，P〈0．05）；总并发症发生率、术后住院日、总住院费用两组差异无统计学意义（P〉0．05）。结论老年患者胰十二指肠切除术后PN联合EN可降低内毒素血症、改善肝功能、减少术后感染并发症。

Comparison of the benefits of combined nutrition support with enteral nutrition and parenteral nutrition versus sole parenteral nutrition support for elderly patients after pancreaticoduodenectomy

Objective To compare the benefits of the combined nutrition support with enteral nutrition (EN)and parenteral nutrition(PN)versus sole PN for elder patients after pancreaticoduodenectomy.Methods The clinical data of 48 consecutive elderly patients who underwent Whipple operations in Beijing Hospital were retrospectively analyzed.Patients were divided into PN+EN group(n=25)and sole PN group(n=23)according to the nutrition support modes.Demographic data as well as data on liver function,endotoxin levels,and post-operative complications were recorded.Mortality,length of hospital stay,and total costs of post-operative management were compared between two groups.Results Endotoxin level increased on the 1st post-operative day(POD 1) in two groups,but there is not significant difference,and then gradually decreased in beth two groups;however,the decrease rate(compared with the POD 1 level)was significantly higher in PN+EN group than in PN group on POD 7 and 14(P<0.01).The levels of alanine transaminase,aspartate aminotransferase,total bilirubin,and direct bilirubin increased on POD 1 in both groups,but there is not significant difference,and then gradually decreased;however,the decrease rates(compared with the levels on POD 1)were also significantly higher in PN+EN group than in PN group(P<0.05)on POD 14.Infective complication rate in group PN+EN(2/25,8.0%)was significantly lower than that in group PN(6/23,26.0%)(P<0.05).Total complication rate,post-operative hospital stay,and total costs were similar between these both groups.Conclusions PN+EN can effectively reduce endotoxemia and post-operative infective complications and improve liver function without increasing costs.Therefore,it is feasible for elderly patients after pancreaticoduodenectomy.