恶性阻塞性黄疸术后早期肠内营养对肝肾功能影响.docVIP

恶性阻塞性黄疸术后早期肠内营养对肝肾功能影响 　　【摘要】研究恶性阻塞性黄疸手术后早期肠内营养支持（EEN）与全肠外营养支持（TPN）对肝、肾功能的影响。方法 将36例恶性阻塞性黄疸病人术后随机分为EEN组（16例）和TPN组（20例），均于术后第2d（48h内）开始进行营养支持，EEN液经空肠造口管以肠内营养输注泵滴入，TPN液经深静脉置管滴入。术前及术后第5、7d监测肝、肾功能，进行统计学分析。结果 肝功能检测值EEN组恢复速度较TPN组快，其中血总胆红素（TB）和r-谷氨酰转肽酶（r-GT）于术后第7d时两组差异有统计学意义。肾功能检测值EEN组术后升高幅度较TPN组低、恢复较快，其中尿转铁蛋白（TRF）、N-2酰-β-D-氨基葡萄苷酶（NAG）、α-微球蛋白（α1-mG）于术后第7d两组差异有统计学意义。结论 早期肠内营养支持在促进恶性阻塞性黄疸术后肝、肾功能恢复方面优于全肠外营养支持。 　　【关键词】早期肠内营养；阻塞性黄疸；肝肾功能 　　Effect of early entral nutritional support on liver and renal function in post-operative patients with malignant obstructive jaundice. 　　1Cao yingzhi，2Zhang liping. 　　1The central hospitals of Jiangshan laixi Shandong，266614，China.2The Chinese medicine hospital of laixi shandong，266600，China. 　　[Abstract]Objective To investigate the effect of EEN and TPN on liver and renal function in post-poerative patients with malignant obstructive jaundice. Methods 36 cases with malignant obstructive jaundice admitted beween were randomized to receive postoperative TPN（n=20）or EEN（n=16）Their liver and renal functions were measured before operation and post-poerative day 5 and 7，respectively. Results liver function in EEN group recovered more guickly than those in TPN group after operation. The levels of TB and r-GT were significantly cower on the 7 h day after operation compared to those in TPN group. Renal function in EEN group came down faster than those in TPN group. The levels of TRF. NAG and α1-mG were significantly lower on the 7h day after operation compared to those in TPN group. Conclusion EEN may present better protective to wards liver and renal function compared to TPN in the patients with malignant obstructive jaundice after operation. 　　[Key words]Enteral nutrition； Obstructive jaundice； liver function renal function 　　恶性阻塞性黄疸病人长期，慢性的胆道梗阻，胆汁淤积，胆道感染，同时肠道胆盐缺乏使肠道菌群失调，肠淋巴系统及肠黏膜萎缩，导致肠屏障破坏，通透性增高，肠道内大量的细菌及内毒素易进入静脉系统，造成肝功能损害。由于全身免疫系统失调，从而肠源性内毒素进入体循环，导致内毒素血症，造成组织器官损伤，尤其是肾损伤。此外，恶性梗阻黄疸病人的抹，麻醉时间长，手术创伤大，术后应激反应重，极易并发或加重内毒素血症【1、2】。早期肠内营养支持（EEN）较全肠外