早期肠内联合肠外营养支持治疗对恶性梗阻性黄疸患者临床预后的影响

目的：探讨早期肠内联合肠外营养支持治疗对恶性梗阻性黄疸患者手术后临床预后的影响。方法将48例恶性梗阻性黄疸患者，随机分为治疗组（早期肠内联合肠外营养支持组）与对照组（TPN组）各24例。所有患者在术后综合治疗基础上，对照组每日行完全肠外营养支持治疗直到经口进食；治疗组留置液囊空肠营养管，术后先行静脉营养支持，第3天开始经空肠营养管滴入肠内营养制剂。观察两组患者术后肠功能恢复首次排气、排便时间；两组患者术后第1天、第7天的血清白蛋白和血清前白蛋白变化情况；两组患者术后第7天的谷丙转氨酶、总胆红素、直接胆红素变化情况；平均住院时间及日均住院费用。结果治疗组肠功能恢复首次排气、排便时间短于对照组，差异有统计学意义（P＜0．01）。两组患者手术后第1天血清白蛋白和血清前白蛋白水平与手术前比较均明显下降，差异无统计学意义（P＞0．05）；两组第7天时血清白蛋白和血清前白蛋白水平均升高，以治疗组更明显（P＜0．05）。两组治疗第7天时谷丙转氨酶、总胆红素、直接胆红素水平均较手术前降低，以治疗组更明显（P＜0．05）。治疗组平均住院时间及日均住院费用均少于对照组（P＜0．05）。结论早期肠内联合肠外营养支持治疗能促进胃肠功能恢复、改善营养状况、有利于肝脏功能恢复、降低医疗费用以及缩短住院时间，是恶性梗阻性黄疸患者手术后的首选营养途径。

Effect of early postoperative parenteral nutrition combined with enteral nutrition support on prognosis of patients with malig-nant obstructive jaundice

Objective To investigate the effect of early postoperative parenteral nutrition combined with enteral nutrition support on the prognosis of malignant obstructive jaundice patients after surgery.Methods Forty-eight patients with malignant obstructive jaundice were randomly divided into treatment group（early PN combined with EN group）and control group（TPN group）,and each group had 24 cases.All patients were treated with conventional treatment after surgery.Control group received parenteral nutrition.Patients were given total parenteral nutritional（TPN）supports as routinely from the first postoperative day until oral feeding.Treatment group were supplied with early enteral nu-trition.Patients were given parenteral nutritional supports routinely on the 1st,2nd postoperative day,and then with nutrition through jejunum nutrition tube infusion,gradually increasing the dosage and reducing the venous support.The first exhaust and defecate time recovery of intes-tinal function of two groups were compared.The changes of serum albumin and serum prealbumin were calculated after postoperative 1 day and 7 days.The changes of ALT,total bilirubin and and direct bilirubin were calculated after postoperative 1 day and 7 days.Meanwhile,the average length of hospital stay and average daily hospitalization cost were compared.Results Compared with control group,the first exhaust and defecate time recovery of intestinal function of patients in treatment group were shortened （P〈0.01）.Serum albumin and serum prealbu-min levels of two groups of patients before 1 day after the operation were significantly decreased compared with those before the operation,but the differences in two groups were not statistically significant （P〉0.05 ）.The serum albumin and serum prealbumin levels of two groups 7 days after treatment increased,but the increase in treatment group was more obvious（P〈0.05）.ALT,total bilirubin and and direct bilirubin levels of two groups 7 days after treatment decreased,and the decrease in treatment group was more obvious（P〈0.05）.The average hospital-ization time and average daily hospitalization cost were lower in treatment group than in control group（P〈0.05）.Conclusion Early enteral nutrition support combined with postoperative parenteral nutrition can promote gastrointestinal function recovery,improve nutritional status, promote the liver functional recovery,reduce medical costs,and shorten hospitalization time,which is the first selection nutrition way for ma-lignant obstructive jaundice patients after surgery.