老年患者消化道手术后胃肠外营养相关肝损伤及危险因素分析

目的 探讨老年患者消化道手术后胃肠外营养(PN)相关肝功能损伤发生率及其危险因素. 方法 回顾性分析75例消化道手术后接受PN老年患者资料,包括年龄、身高、体质量、原发疾病、既往史、PN使用时间、总热能、非蛋白热能、脂肪乳剂种类和用量、氨基酸种类和用量、葡萄糖用量、非蛋白热能与氮比值、糖脂比、肝功能、肾功能、血常规. 结果 75例老年患者中,出现PN相关的肝功能损伤19例(25.3%).肝功能损伤组与正常组总热能分别为(24.0±6.5)和(20.7±5.4)kcal·kg-1·d-1,非蛋白热能(20.5±5.5)和(17.2±4.8)kcal·kg-1·d-1,蛋白质(1.0±0.3)和(0.9±0.2)g·kg-1·d-1,葡萄糖用量(2.9±0.9)和(2.3±0.9)g·kg-1·d-1,糖脂比(1.5±0.7)和(1.1±0.5),肝功能损伤组明显高于肝功能正常组,而血红蛋白分别为(97.4±15.1)和(110.1±19.1)g/L,则明显降低.营养液中氨基酸种类(χ2=0.114)和脂肪种类(χ2=0.843)、性别(χ2=0.116)、慢性疾病史(χ2=0.531)、原发疾病(χ2=0.344)、体质指数(χ2=1.588)、血白蛋白(χ2=0.006)和白细胞水平(χ2=0.063)、肾功能(χ2=0.549)均未对PN相关肝功能损伤产生明显影响(均为P>0.05). 结论 老年人消化道手术后PN相关肝功能损伤发生率为25.3%,老年患者应用PN时应适当减少热能,降低葡萄糖用量和糖脂比.

The prevalence of parenteral nutrition-associated liver disease and its risk factors in elderly people after gastrointestinal operation

Objective To explore the prevalence of parenteral nutrition-associated liver disease (PNALD) and its risk factors in elderly people after gastrointestinal operation. Methods Seventy-five patients received parenteral nutrition (PN) after gastrointestinal operation were retrospectively analyzed. Age, height, body mass index, suftering diseases, history of diseases, time of therapy, total calorie, nonprotein calorie, the kind and amount of fat emulsion and amino acid, the amount of glucose, non-protein energy to nitrogen ratio, ratio of glucose to lipid, liver function, renal function and blood routine were collected. Results The prevalence of PNALD was 25.3% (19/75). The total calorie, nonprotein calorie, the amount of protein, the amount of glucose and ratio of glucose to lipid were obviously higher in PNALD group than in non-PNALD group [(24.0±6.5) vs. (20.7±5.4)kcal·kg-1·d-1, (20.5±5.5)vs. (17.2±4.8)kcal·kg-1·d-1, (1.0±0.3)vs. (0.9±0.2)g ·kg-1·d-1, (2.9±0.9)vs.(2.3±0.9)g·kg-1·d-1, 1.5±0.7 vs. 1.1±0.5; all P<0.05], while the hemoglobin was lower in PNALD group [(97.4±15.1)vs. (110.1±19.1)g/L, P<0.05]. The kind of fat emulsion and amino acid, gender, history of diseases, suftering diseases, body mass index, serum albumin, leukocyte levels and renal function were comparable between the two groups (χ2=0.114,0.843,0.116,0.531,0.344,1.588,0.006,0.063 and 0.549, all P>0.05). Conclusions The prevalence of PNALD is 25.3% in 75 elderly patients after gastrointestinal operation. Total calorie, the amount of glucose and the ratio of glucose to lipid should be reduced in these patients for preventing PNALD.