低氮低热量肠外营养对食管癌术后营养状态、血糖和并发症的影响.docVIP

低氮低热量肠外营养对食管癌术后营养状态、血糖和并发症的影响 　　【摘要】 目的：评价低氮低热量肠外营养对食管癌术后营养状态、血糖和术后并发症的影响。方法：2012年1月-2013年12月，将60例符合标准的食管癌患者按照1：1的比例随机分为低氮低热量组（研究组）和传统氮热量组（对照组），每组30例，均行开胸食管癌切除胸内吻合术。术后前5 d采用全肠外营养支持治疗，研究组按热量20 kCal/（kg?d），氮0.1 g/（kg?d）给予，对照组按热量35 kCal/（kg?d），氮0.2 g/（kg?d）给予。术后观察并记录患者并发症的发生率。术前1 d、术后第3、6天测定血浆总蛋白、白蛋白、前白蛋白，术前和术后第1、3、6天查动脉血气测PaO2、PaCO2、乳酸浓度等指标，并在输注肠外营养开始后3 h测末梢血糖。结果：术后第3天和术后第6天两组各蛋白指标均较术前有所降低，但是差异无统计学意义（P0.05）；研究组术后第1、3、6天的PaO2显著高对照组（P0.05）；研究组术后总的并发症发生率显著低于对照组（P0.05）。结论：食管癌术后低氮低热量肠外营养与传统氮热量相比营养状态相似，但能更好控制术后血糖水平，有利于降低肺损伤及降低总的并发症发生率。 　　【关键词】 低氮低热量； 肠外营养； 营养状态； 血糖； 并发症 　　【Abstract】 Objective：To assess the impact of hypocalorie and lower nitrogen parenteral nutrition on blood glucose，postoperative complications and nutritional status of patients underwent esophageal resection. Method：Sixty patients underwent esophageal resection from January 2012 to December 2013 were divided into two groups by 1：1 ratio randomizely. All the patients received total parenteral nutrition （TPN） in postoperative 5 days.Study group（n=30）received calorie 20 kCal/（kg?d） and nitrogen 0.1 g/（kg?d）in 3 L bag. Control group （n=30） received calorie 35 kCal/（kg?d）and nitrogen 0.2 g/（kg?d） in 3 L bag. The postoperative complications，the concentration of total protein， albumin， prealbumin on the 1st day before surgery and the 3rd，6th day after surgery， the concentration of PaO2， PaCO2 and lactic acid of arterial blood on the preoperative day and the 1st， 3rd ， 6th day after surgery， the peripheral blood glucose at the 3 hours after parenteral nutrition were recorded identify the difference between two groups. Result：The concentrations of total protein ，albumin， prealbumin in two groups on the 3rd ， 6th day after surgery were lower than preoperative concentrations without significant differences between two groups （P0.05）. The concentration of PaO2 in study group on the 1st， 3rd ， 6th day after surgery were higer than that in control group with significant difference （P 　　【Key words】 Parenteral nut