部分肠内营养支持对肝硬化病人治疗效果.docVIP

部分肠内营养支持对肝硬化病人的治疗效果 　　作者：周召海,彭永鹏,张建立　　作者单位：1 青岛大学医学院附属医院东区普外科，山东 青岛 266071; 2 平度市人民医院传染科 　　【摘要】目的 探讨部分肠内营养(PEN)对肝硬化病人的治疗效果。方法 43例肝硬化病人按病人意愿分为PEN组与部分肠外营养 (PPN) 组，两组分别给予PEN及PPN支持治疗10 d，于治疗前和营养支持后第7、10天分别测定血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)及转铁蛋白(TRF)、前清蛋白(PAB)和清蛋白(Alb)各项指标的变化。结果 治疗第10天两组ALT、AST与TB均明显低于治疗前(F=5.67～11.32，q=3.35～3.96,P0.05)，并且PEN组下降幅度明显大于PPN组(t=2.30～4.32,P0.05)。进行营养支持7 d后，两组TRF和PAB较营养前明显升高(F=10.80～30.24，q=3.90～11.53,P0.05)，两组比较无明显差异。第10天时，PAB、TRF与Alb等3种指标均明显高于治疗前(F=30.30～112.24，q=13.90～22.53,P0.05)，且PEN组明显高于PPN组(t=2.65～5.61，P0.05)。结论 PEN与PPN都能促进肝硬化病人肝功能与能量代谢的恢复，但PEN的效果更明显，优势更大。 　　【关键词】 肝硬化,肝功能,肠道营养,胃肠外营养,治疗结果 　　[ABSTRACT] Objective To evaluate the therapeutic effect of partial enteral nutrition (PEN) on patients with liver cirrhosis. Methods According to their wish, 43 cirrhotic patients were divided into PEN (23 cases) and partial parenteral nutrition (PPN, 20cases) groups and given PEN or PPN, separately, for 10 days. The ALT, AST, TB, TRF, PAB and Alb were determined before and on the 7th and 10th day after treatment. Results On day 10 of the treatment, the levels of ALT, AST and TB in both groups were significantly lower than those before treatment (F=5.67-11.32;q=3.35-3.96;P0.05), but it was more lower in PEN group (t=2.30-4.32,P0.05). After seven days of treatment, the TRF and PAB were increased compared with before treatment (F=10.80-30.24;q=3.90-11.53;P0.05), the diffrences between the two groups were not significant; on day 10, the levels of PAB, TRF and Alb were higher than the levels of before treatment (F=30.30-112.24;q=13.90-22.53;P0.05), the levels being higher in PEN group (t=3.85-5.61,P0.05). Conclusion Both PEN and PPN can improve the liver function and energy metabolism in patients with liver cirrhosis, but the effect of PEN is much better. 　　[KEY WORDS] Liver cirhosis; Liver function; Enteral nutrition; Parenteral nutrition; Treatment outcome 　　肝硬化病人均有不同程度的营养不良，合理的营养支持治疗有利于改善肝功能，防治并发症。目前临床上有肠内营养(EN)和肠外营养(PN)两种营养支持方式。PN