胰十二指肠切除术后营养支持方式的探讨

目的:比较肠内营养(EN)和肠外营养(PN)支持对胰十二指肠切除(PD)术后病人营养状态的改善、术后并发症发生率的影响,探讨PD术后营养支持的意义及临床应用的价值。方法:在2008年至2011年间,按特定筛选标准入组40例病人。通过随机对照的方法比较PD术后病人EN和PN支持模式后的营养状态、术后并发症发生率的变化。结果:PN组和EN+PN组白蛋白和转铁蛋白水平在术前1 d,术后第7、10天无统计学差异(P>0.05);前白蛋白水平在术后第7、10天有统计学差异(P0.05),但EN+PN组并发症总数明显少于PN组(P<0.05)。PN组病人出现肝功能损害机会较大(P<0.05),EN+PN组病人中心静脉导管拔除时间和住院时间均明显短于PN组,住院费用也明显少于PN组(P<0.01)。结论:PD术后病人PN和EN支持对营养状况都有明显改善作用,PN营养支持在术后早期相对EN有一定优势,但长期应用存在较多不利因素,在胃肠功能恢复后,应尽早行消化道EN,并以EN和PN联合方式进行术后营养支持。

Different nutritional support mode after pancreaticoduodenectomy

Objective To explore an appropriate nutritional mode after pancreaticoduodenectomy(PD) by comparing the nutritional status and the incidence of postoperative complications between enteral nutrition(EN) and parenteral nutrition(PN) support for patients after PD.Methods According to inclusion criteria,40 cases during Jan 2008 to Dec 2011 were randomly grouped into EN or PN support.Differences in the postoperative nutritional status and the incidence of postoperative complications were compared.Results Postoperative nutritional status that is albumin and transferrin levels did not differ on the day before surgery,postoperative day 7 and day 10 between PN group and EN+PN group(P>0.05).However,PN group had higher level of pre-albumin on postoperative day 7,and day 10(P<0.01).No difference in the incidence of postoperative complications was found between two groups(P>0.05).The total complications was significantly lower in EN+PN group than in PN group(P<0.05).PN group had higher proportion of impaired liver function(P<0.05).The duration of central venous catheter indwelling was shorter in EN+PN group.Furthermore,hospital stay was shorter in EN+PN group and the costs less(P<0.01).Conclusions PN and EN support significantly improved the nutritional status for patients after PD.PN had some advantages over EN support in the early postoperative phase,but was unfavorable for prolonged support.When digest tract function recovered,EN support should be applied as early as possible and a joint support of EN with PN is recommended.