早期肠内营养支持在门脉高压行TIPS术后患者中的应用价值

目的　研究早期肠内营养支持方案对门脉高压行经颈静脉肝内门-体分流术（TIPS）后患者应激反应水平、肝功能及营养状态的影响。方法　进行前瞻性研究，选取2018年7月至2020年10月期间河南科技大学第一附属医院95例肝硬化门脉高压症TIPS术后患者作为研究对象，采用随机数字表法分为对照组47例和观察组48例。对照组男32例、女15例，年龄（48.32±4.25）岁，给予常规营养支持；观察组男32例、女16例，年龄（49.61±4.41）岁，给予早期肠内营养支持方案。对比两组患者肝功能、应激反应水平、营养状态。计数资料采用χ²检验，计量资料采用t检验。结果　观察组干预后血清白蛋白（Alb）水平为（39.68±4.23）U/L，高于对照组（35.89±4.50）U/L，总胆红素（TBil）水平为（14.22±2.63）μmol/L，低于对照组（18.54±2.15）μmol/L，差异均有统计学意义（均P<0.05）。观察组干预后转铁蛋白（TRF）水平、前白蛋白（PA）水平、预后营养指数（PNI）分别为（2.78±0.30）g/L、（3.33±0.42）g/dl、（58.24±3.34），均高于对照组（2.53±0.38）g/L、（2.98±0.40）g/dl、（55.62±3.85），差异均有统计学意义（均P<0.05）。观察组干预后C反应蛋白（CRP）、凝血酶原时间（PT）水平分别为（14.08±3.62）mg/L、（13.42±0.62）s，均低于对照组（20.35±4.25）mg/L、（15.75±0.80）s，差异均有统计学意义（均P<0.05）。结论　早期肠内营养支持方案对肝硬化门脉高压症TIPS术后患者效果确切，能够有效改善患者营养状态和肝功能，降低应激反应水平，具有临床推广价值。

Value of early enteral nutritional support in patients undergoing TIPS for portal hypertension

Objective　To investigate the effects of early enteral nutrition support program on stress response level, liver function, and nutritional status in patients undergoing transjugular intrahepatic portal-body shunt (TIPS) for portal hypertension. Methods　A prospective study was conducted on 95 cirrhotic portal hypertension patients after TIPS surgery in The First Affiliated Hospital of Henan University of Science and Technology from July 2018 to October 2020. The patients were divided into two groups by the random number table method. The control group consisted of 47 patients, 32 males and 15 females, aged (48.32±4.25) years; the observation group consisted of 48 patients, 32 males and 16 females, aged (49.61±4.41) years. The control group received routine nutritional support, and the observation group received early enteral nutrition support program. The liver function, stress response level, and nutritional status were compared between the two groups. χ² test was used for the count data and t test was used for the measurement data. Results　After intervention, the serum albumin (Alb) level in the observation group was (39.68±4.23) U/L, which was higher than that in the control group (35.89±4.50) U/L], and the total bilirubin (TBil) level was (14.22±2.63) μmol/L, which was lower than that in the control group (18.54±2.15) μmol/L], with statistically significant differences (both P<0.05). After intervention, the levels of transferrin (TRF) and prealbumin (PA) and prognostic nutrition index (PNI) in the observation group were (2.78±0.30) g/L, (3.33±0.42) g/dl, and (58.24±3.34), which were higher than those in the control group (2.53±0.38) g/L, (2.98±0.40) g/dl, and (55.62±3.85)], with statistically significant differences (all P<0.05). After intervention, the levels of C-reactive protein (CRP) and prothrombin time (PT) in the observation group were (14.08±3.62) mg/L and (13.42±0.62) s, which were lower than those in the control group (20.35±4.25) mg/L and (15.75±0.80) s], with statistically significant differences (both P<0.05). Conclusions　Early enteral nutrition support program has a definite effect on patients with cirrhotic portal hypertension after TIPS, which can effectively improve their nutritional status and liver function and reduce their stress response level, with clinical promotion value.