早期肠内营养支持在肝癌患者肝移植术后的应用

目的：探讨肝癌患者肝移植术后早期肠内营养（ＥＮ）支持的价值。方法：将６５例肝癌肝移植患者分为两组：２５例术后给予肠外营养（ＰＮ组），４０例术后早期给予肠内营养（ＥＮ组）。比较两组术后机械通气时间、住ＩＣＵ天数、２８天感染发生率、２８天死亡率及术后１、４、７天肝功能、营养状态、免疫指标。结果：两组性别、年龄、肝功能Ｃｈｉｌｄ分级、供肝热缺血时间、冷缺血时间、无肝期、手术时间、机械通气时间、ＩＣＵ住院天数等比较无差异（Ｐ＞００５）。术后第７天，ＥＮ组较ＰＮ组ＴＢＩＬ、ＤＢＩＬ、ＡＬＴ、ＣＲＰ显著降低（Ｐ＜００５），Ｐａｂ、ＴＦＮ、ＩｇＡ、ＩｇＭ显著升高（Ｐ＜０.０５）。ＥＮ组较ＰＮ组术后２８天感染率明显降低（Ｐ＜０.０５）。两组２８天内均无死亡病例。ＥＮ组主要并发症为腹胀、腹泻、营养导管堵塞或滑脱。结论：肝癌患者肝移植术后早期ＥＮ比ＰＮ能更有效地改善患者的营养状况，促进患者肝细胞的修复，降低Ｃ反应蛋白水平，提高机体的免疫力，显著减少感染的发生。

Enteral nutrition support at early period used in patients with liver cancer after liver transplantation

Objective：To discuss the value of enteral nutrition support at early period in patients with liver cancer after liver transplantation. Methods：Sixty-five patients after early operation who received liver transplantation were randomly divided into paren- teral nutrition group（ PN, n = 25） and enteral nutrition group（ EN, n = 40） , the time of mechanical ventilation and days of stayed in ICU, the rate of infection and death during 28 days, and the liver function, nutrition and immunity function in the first, the forth and seventh day after operation were compared with two groups. Results：There＇s no significantly difference between the two groups in sex, age, liver function, warm iscbemic time of the donor liver, cool isehemic time, anhepatic phase, the time of mechanical ventilation and the days of stayed in the ICU （P 〉 0. 05 ）. In the seventh day after the transplantation, TBIL, DBIL, ALT, CRP had significantly decreased in the EN group compared with the PN group（ P 〈 0.05 ） ,Pab, TFN, IgA and IgM had significantly increased （ P 〈 0. 05 ）. The infection rate in 28 days after the transplantation had significantly reduced in the EN group compared with the PN group （P 〈 0. 05）. There＇s no death case in either group in 28 days. The main complications in EN group were abdominal distension, diarrhea, and blockage of the feeding pipe, or scaling of the feeding pipe. Conclusion： The enteral nutrition could more efficiently improve the nutrition state of the liver cancer patients after liver transplantation compared with parenteral nutrition, as well as promoting the restoration of liver cells, reducing the CRP level, improving the patients＇ immunity, and cutting the infection rate.