肠内和肠外营养对上消化道肿瘤术后肠瘘患者的临床应用研究

目的提高上消化道肿瘤术后并发肠瘘患者的营养支持效率.方法 28例患者随机分为肠内和肠外营养支持两组,前者用市售普通营养制剂由空肠营养管持续滴入,进行管饲调节喂养.瘘口封闭后改由口服.后者采用深静脉置管,进行静脉营养支持.两组在热卡,糖、蛋白质、脂肪的组成比例及电介质、微量元素的含量等均相似.营养支持开始后第7、14、21、28、35天清晨空腹采血.检测血浆丙二醛（MDA）及超氧化物歧化酶（SOD）活力变化.测定血浆前白蛋白及转铁蛋白、血浆内毒素.结果肠内营养组的MDA及内毒素水平明显低于肠外营养支持组.结论肠内营养支持可保护肠道功能,减轻肠道缺血再灌注损伤,降低循环内毒素水平,明显改善患者的营养状态.

A clinical appraisal of enteral nutrition and parenteral nutrition on patients complicated with intestinal fistula after resection of upper gastrointestinal tumor

Objective To improve the effects of the nutrient support on patients complicated with intestinal fistula after upper gastrointestinal tumor resection.Methods A total of 28 cases were randomly assigned to receive enteral nutrition(EN) and parenteral nutrition(PN).The proportion of calory,sugar,protein,and fat was matched for the patients supported by either EN or PN.On day 7,14,21,28,35 after nutrient support,the serum MDA,SOD activity,and the serum prealbumin,transferrin,endotoxin were detected.Results The serum level of MDA and endotoxin in the patients with EN was significantly lower than those with PN.Conclusion EN could improve the whole nutrient state,preserve the intestinal function,reduce reperfusion injury of the gut,decrease the serum level of endotoxin,but also shorten hospital stay and reduce the charges.