摘要
目的 通过比较不同营养支持方案的作用,评价ω-3多不饱和脂肪酸联合营养支持治疗在肝切除术后应用的临床效果。方法 采用回顾性对照研究的方法.选择2009年1月-2011年1月南京大学医学院附属鼓楼医院82例行肝切除术患者,依照围手术期不同的营养支持方案分为全肠外营养组（23例,简称肠外组）、联合肠内营养组（30例,简称肠内组）和ω-3不饱和脂肪酸组（29例,简称ω-3 PUFAs组）。肠外组术后给予全肠外营养支持;肠内组在静脉营养支持基础上术后早期口服肠内营养;ω-3 PUFAs组在肠内组基础上,术后加用ω-3多不饱和脂肪酸。通过比较3组患者术后恢复情况、并发症发病率、肝功能等临床指标综合评估不同营养支持方案的疗效。结果 （1）3组患者术后均无胆漏、胆道出血等严重并发症,轻微并发症包括腹腔积液、胸腔积液,3组间差异无统计学意义;（2）与肠外组比较,肠内组、ω-3 PUFAs组术后排便时间、术后住院天数较短,差异有统计学意义（P =0.001,=4.624;P =0.001,t =5.019）;肠内组、ω-3PUFAs组间差异无统计学意义（P＞0.05）;（3）对于大范围（≥4个肝段）肝切除患者,与肠内组相比,ω-3PUFAs组术后第3、5天ALT值较低,差异有统计学意义（P=0.024,t=2.432;P=0.042,=2.144）;（4）对于有肝硬化的患者,与肠内组相比,ω-3 PUFAs组术后第3、5天胆红素值较低,差异有统计学意义（P=0.032,t=2.202;P=0.035,t =2.183）。结论 肝切除术后早期给予肠内营养并联合肠外营养支持,可加速患者康复;对于有肝硬化背景及大范围肝切除的患者,ω-3 PUFAs联合营养支持治疗对肝功能的保护作用尤为明显。
Objective By comparing the therapeutic effects of different nutrition support,to elementarily evaluate the protocol of nutrition support with ω-3 polyunsaturated fatty acids in patients undergoing hepatectomy.Methods Retrospective and comparative analysis was applied.From January 2009 to January 2011,82 patients undergoing liver resection were selected from Nanjing Drum Tower Hospital and divided into three groups according to different nutrition supporting protocol：total parenteral nutrition group （23,TPN for short）,combined enteral nutrition group （30,EN for short）,ω-3 PUFAs group （29）.TPN group was given total parenteral nutrition.EN group was given both parenteral and enteral nutrition.ω-3 PUFAs group was given parenteral nutrition,enteral nutrition and ω-3 PUFAs.By comparing the general situation,the incidence of post-operation complications and index of liver function,the effect of different nutrition supporting plans could be comprehensively evaluated.Results （1） None patients from any groups had severe complications such as bile leakage and hemobilia.Slight complications included ascites and pleural effusion.No difference is of significance in statistics science.（2） Compared with TPN group,patients from EN and ω-3 PUFAs group had shorter defecating time and post-surgery hospital stay,the difference is of significance in statistics science （P =0.001,t =4.624; P =0.001,t =5.019）.There was no significant difference between EN and ω-3 PUFAs group （P ＞ 0.05）.（3） For patients received operation with major hepatectomy （≥4 segments）,ALT in ω-3 PUFAs group was lower than EN group in the 3rd and 5th day after operation （P=0.024,t =2.432; P=0.042,t =2.144）.（4） For patients with cirrhosis,TB in ω-3 PUFAs group was lower than EN group in the 3rd and 5th day after operation （P =0.032,t =2.202; P =0.035,t =2.183）.Conclusions It is beneficial to use nutritional support in patients received hepatectomy.For patients received major hepatectomy and patients with c
出处
《国际外科学杂志》
2014年第4期253-257,共5页
International Journal of Surgery
基金
江苏省医学重点人才基金资助（No.RC2011003）
