胰十二指肠切除术后患者临床营养的护理

目的总结胰十二指肠切除术后患者肠外营养（PN）和肠内营养（EN）的护理体会。方法回顾性分析了57例接受胰十二指肠切除术患者的临床资料，所有患者均于术前接受中心静脉置管，术中行空肠造瘘，术后给予PN和EN支持。结果PN中位时间为8天（5～24天），EN中位时间为21天（5～69天），平均术后肛门排气时间（72．5±19．8）小时，术后住院的中位时间为24天（17～74天）。57例患者中，1例于围手术期死亡，2例因严重腹胀、腹泻中止EN；41例出现腹胀，17例发生腹泻；中心静脉导管脱出和堵塞各2例，空肠造瘘未出现导管并发症；29例出现糖代谢严重异常，2例伤口裂开，19例次发生术后感染。结论胰十二指肠切除术后需要联合PN和EN，治疗中应坚持无菌配液、严格管路护理、注意血糖变化和加强心理治疗。

Clinical Care of Parenteral Nutrition and Enteral Nutrition Support on Post-pancreatoduodenectomy Patients

Objective To summarize the clinical care experience of parenteral nutrition （PN） and enteral nutrition （EN） support on patients who have undergone pancreatoduodenectomy. Methods We retrospectively analyzed the clinical data of 57 patients who received PN and EN support by central venous catheter and jejunostomy after pancreatoduodenectomy. Results The median duration of PN was 8 days （5 - 24 days） , the median duration of EN was 21 days （5 - 69 days）, the mean postoperative anal exhaust time was （72.5 ± 19.8 ） hours, and the median postoperative hospitalization was 24 days （ 17 - 74 days）. Among 57 patients, 1 patient died during peri-operational period, 2 patients quit nutrition support due to severe distention and diarrhea; 41 patients had distention, 17 patients had diarrhea; 2 patients had catheter occlusion, 2 patients had catheter dislocation, and no patients had jejunostomy-related complications ; 29 patients had severe disorder in glucose metabolism, 2 patients had wound dehiscence, and 19 patients had postoperative infections. Conclusions PN and EN combined support is important for patients after pancreatoduodenectomy. Clinical care of PN and EN should ensure sterility of the nutritional emulsions, strengthen tube maintenance, monitor blood glucose changes, and enhance psychological nursing.