胃肠道、胰腺术后早期肠内营养的应用

目的　观察胃肠道、胰腺术后早期肠内营养支持的效果。方法　选择胃肠道、胰腺手术后患者共计 68例 ,分成 2组 ,A组为肠内营养组 (EN) ,B组为对照组。A组应用肠内营养输注系统 ,在手术后 6h开始均匀输注瑞素 ,观察肠内营养支持期间的临床表现 ,并测定肠内营养支持前、后患者的血常规、血糖、肝肾功能、电解质体液免疫指标和营养指标 ,以及术后并发症。结果　术后肛门排气恢复时间A组比B组早 (P <0 0 1) ;A组应用瑞素后 4例出现恶心、呕吐 ,经减慢输注速度后得以缓解 ,3例出现腹痛 ,经调整温度后缓解 ,3例出现腹泻 ,无机械性肠梗阻、肠瘘和代谢性并发症发生。A组应用瑞素后 ,前蛋白比B组升高 (P <0 0 5 ) ,术后第 11天 2组测血IgA、IgG、IgM ,与术前相比 ,B组下降非常明显 (P <0 0 1) ,而EN组略高于术前。结论　胃肠道、胰腺术后通过鼻肠管、空肠造口管应用瑞素进行早期肠内营养是安全有效的 ,有利于胃肠功能的恢复 ,对改善患者机体的营养状况具有积极意义 ,也易为患者所接受。

EARLY ENTERAL NUTRITION WITH FRESUBIN AFTER GASTROINTESTINAL AND PANCREAS OPERATION

Objective To study the effect of early enteral nutrition u si ng Fresubin after gastrointestinal operation and pancreas operation. Me thods 68 postoperative patients were divided into two groups. The jeju nostic tube group (A group, n=50) received the enteral nutrition (Fresubin) 6h after operation, and the control group (B group, n=18) received the intra venous infusion and then the oral liquid diet after the bowel movement recovery. The clinical finding, operative complications, blood glucose, the function of l ive and kidney, IgA, IgM, IgG, electrolytes and nutrition status were observed. Results The recovery of bowel movement in group A was much ea rlier than that in group B (P<0.01). Nausea and vomiting occurred in four patients and relieved by slowing the administration rate in group A. Abdominal p ain occurred in three patients and relieved by regulating the temperature of Fre subin in group A. Diarrhea occurred in three patients. No patient had the compli cations such as intestinal obstruction, intestinal fistula and metabolic disorde r in group A and the levels of prealbumin and RBP were significantly higher in g roup A than those in the control group. Conclusions Using Fre subin for early enteral nutrition through jejunostic tube is safe and effective after gastrointestinal operation and pancreas operation and effective after gast rointestinal operation. It is beneficial to the recovery of gastrointestinal fun ction and effective after gastrointestinal operation and has a positive role in improving the patients′ nutritional status. KEY WORDS early enteral nutrition; gastrointestinal and pancreas oper ation; Fresubin