富含中链脂肪酸和蛋白的肠内营养对恶性梗阻性黄疸手术病人肠屏障功能的影响

目的 :观察富含中链脂肪酸和蛋白的肠内营养(Nutrison MCT)和普通肠内营养混悬液(Nutrison MF)两种肠内营养混悬液对恶性梗阻性黄疸手术病人肠粘膜屏障功能的影响。方法 :将82例需手术的恶性梗阻性黄疸病人随机分为MCT组(40例)和MF组(42例)。病人入院后予口服营养制剂。术后胃肠功能恢复后自空肠营养管逐步使用肠内营养直至全量肠内营养治疗5 d,5 d后根据个体情况逐步停止肠内营养。测定入院后第2天、术前1天、全量用药5 d后两组病人血浆内毒素水平和二胺氧化酶(DAO)活性,以及尿液乳果糖与甘露醇(L/M)比值。结果 :两组病人入院后2天和手术前1天相比,血浆内毒素水平、DAO活性和尿L/M比值的差异均无统计学意义。两组病人术后全量用药5天后内毒素水平、二胺氧化酶(DAO)活性和尿L/M比值均较术前降低,且MCT组较MF组降低更明显。结论 :Nutrison MCT相比Nutrison MF可以更早的改善恶性梗阻性黄疸手术病人肠粘膜屏障功能。

Effect of high amounts of medium chain triglyceride and protein enteral nutrition on gut barrier function during the perioperative period in patient with malignant obstructive jaundice

Objective:To investigate the effect of Nutrison MCT and Nutrison MF enteral nutrition on gut barrier function during the perioperative period in patient with malignant obstructive jaundice.Methods:82 cases of patients with malignant obstructive jaundice were randomized divided into Nutrison MCT group with 40 cases and Nutrison MF group with 42 cases.Enteral nutrition was given on admission.The level of urinary lactulose and mannitol(L/M) ratio,plasma endotoxin and diamine oxidase(DAO) activity on the 2nd day after admission,lday before surgery,5 days after full dose of enteral nutrition were collected.Results:Before surgery,no statistical significance difference of urinary L/M ratio,plasma endotoxin and DAO activity were found between the 2nd day after admission and 1day before surgery.After full dosing of enteral nutrition,urinary L/M ratio,plasma endotoxin and DAO activity were decreased,while Nutrison MCT group decreased more significantly than Nutrison MF group.Conclusion:Nutrison MCT can improve the gut barrier function of patients with malignant obstructive jaundice more earlier than Nutrison MF after surgery.