腹部手术病人在肠外营养基础上早期少量肠道喂养的临床研究

目的观察腹部手术后早期少量肠道喂养的作用和安全性。方法选取我院99年7月至1月的腹部大中型手术病人30例，随机分为研究组15例(肠外营养+早期喂养)，男9例，女6例，平均50.1岁(24～68)。对照组15例(单纯肠外营养)男10例，女5例，平均为48.2岁(23～70)。病种研究组和对照组肠道病分别为3例，5例，胃病分别为4例、3例，结肠疾病为5例、4例，直肠为3例，3例，两组采用等热量等氮量的肠外营养。研究组于术后24小时给予少量小于总能量的15%)。术后3天，7天对患者的体重，血浆白蛋白，氮平衡和胃肠功能恢复时间进行比较。结果2组病人术后3天体重均有下降，而对照组下降明显，与治疗组比较差异有显著性P<0.05，术后7天病人体重回升，治疗组更明显，与对照组比较差异有显著性P<0.05。两组血浆白蛋白明显下降，与术前比较差异有显著性P<0.05，术后7天治疗组升高至34.2±3.0与对照组31.9±3.05比较差异有显著性P<0.01。氮平衡术后3天，7天治疗组均比对照组获得更好的氮平衡，两组对比差异显著P<0.01。治疗组肠蠕动恢复时间对照组提前，两组对比差异显著P<0.01。治疗组置胃管时间缩短，减少肺部并发症发生。结论术后早期少量肠道喂养能辅助肠外营养的支持和治疗作用，促进胃肠功能恢复，维护胃肠粘膜屏障功能，减少术后并发症，无副作用。

Effect of early enteralnutrition in patients receiving abdominal surgery

Objective To evaluate the safety and effect of early enteralnutrition support in patients receiving abdominal surgery. Methods 30 patients undergoing abdominal surgery were randomized into two groups:study group(PN and early EN),control group(PN).Patients in study group received enteral nutrition from 24 hours after operation.The energy provided by EN was less than 15% of total energy.All the patients were given isonitrogenic and isocaloric nutrition support.Body weiht,plasma albumin,nitrogen balance and enterocinesia were evaluated on the 3rd and 7th postoperative day. Result Body weight decreased significantly in control group compared to that in the study group on the 3rd postoperative day (P<0.05),increased significantly in the study group compared to that n the control group on the 7th postoperative day (P<0.05).A significant decrease in plasma albumin level was observed on 3rd and 7th postoperative day compared to that preoperative (P<0.05).The level of plasma albumin in study group was significantly better than that in control group (P<0.01).Nitrogen balance in the study group was significantly better than that in the control group on 3rd and 7th postoperative day (P<0.01).The enterocinesia recovered significantly earlier in study group than in control group (P<0.01).No adverse reaction related to early EN was observed. Conclusion Enteral nutrition in the early period after abdominal surgery is safe and effective.