摘要
目的 比较不同的营养治疗支持方式对肝癌合并肝硬化患者肝切除术后恢复的影响作用.方法 选择可切除的肝癌肝硬化患者212例术后随机分成常规热量肠外营养组（traditional parenteral nutrition,PN）77例、低热量肠外营养组（hypocaloric parenteral nutrition,HPN）70例和低热量肠内营养组（hypocaloric enteral nutrition,HEN）65例3组,PN组和HPN组术后营养支持能量需求分别为（25～30）kcal/（kg·d）和（16 ～20） kcal/（kg·d）,经中心静脉输注;HEN组术后能量需求为20kcal/（kg·d）,术后早期（术后24h）经鼻肠营养管加营养泵控制输注;比较3组患者在术后5天短期内经过不同营养支持方式治疗后患者的营养状态、胃肠道功能、肝功能、并发症发生率、术后住院时间和营养支持治疗费用的差别.结果 三组患者在手术之前机能状况无统计学差异,术后7天HEN组患者血清总胆酸（TBA）和总胆红素（TBIL）值明显低于PN组和HPN组（P＜0.05）,胃肠道功能恢复时间3组患者分别是56.4h、78.8h和74.4h（P ＜0.05）;营养支持治疗的相关费用分别是412元、977元和714元（P＜0.05）;术后住院时间分别是10.1天、13.4天和11.1天（P＜0.05）,并发症发生率分别是7.4％、12.2％和11.7％ （P ＜0.05）.结论 肝癌肝硬化患者术后采用HEN支持的治疗方式,在恢复患者胃肠道功能、提升肝脏合成蛋白的能力和改善淤胆状态、降低术后并发症等方面优于其他治疗方式;同时HEN治疗可降低患者经济负担,缩短住院时间;低热量的营养支持更加符合肝癌肝硬化患者术后的生理代谢需求.
Objective To study the effect of different nutrition support methods on primary liver cancer patients with hepatectomy：a controlled prospective study.Methods Totally 212 patients with HCC and hepatic cirrhosis were enrolled in this research and were divided into three groups.Seventy-seven patients were provided with traditional parenteral nutrition （PN）,70 patients with hypocaloric parenteral nutrition （HPN） and 65 patients with hypocaloric enteral nutrition （HEN）.The energy support for PN and HPN groups were （25-30） kcaL/（kg · d） and （16-20）kcaL/（kg · d） seperately through under collarbone central venous catheter per day.The energy for HEN patients was 20kcal/（kg · d）.In HEN group,naso-enteral tube was placed preoperatively.Multiple factros were compared among these three groups receiving nutrition support for 5 days postoperatively,including nutrition status,hepatic function,gastrointestinal function,complication rates,postoperative hospitalization time and nutrition expenses.Results No statistical difference was observed among the three groups in patient status before operation.TBA and TBIL were significantly lower in HEN group than in PN and HPN group at 7th day after surgery （P ＜ 0.05）.The length of gastrointestinal restoration in three groups were 56.4,78.8 and 74.4 hours （P ＜ 0.05）.The hospitalization time were 10.1 days,13.4days and 11.1days （P ＜ 0.05） and complication rates were 7.4％,12.2％ and 11.7％ （P ＜ 0.05）.The weight loss during the hospitalization were 1.7kg,2.7kg and 2.1 kg （P ＜ 0.05）.The nutrition expenses were 412 yuan,977 yuan and 714 yuan （P ＜ 0.05）.There were no significant difference in hepatorenal function and immune function.Conclusion For patients with HCC and hepatic cirrhosis,HEN is a better choice,because it can shorten the recovery time of gastrointestinal function,improve bile stasis,promote protein formation,decrease complication rates during hospitalization.Furthermore,HEN may shorten hospitalization time and reduce nutrition expense.In general,enteral nutrition is more superior than parenteral ones in postoperative nutrition support.Hypocaloric nutrition support is more suitable for physiological demand of patients with HCC and cirrhosis after surgery.
出处
《医学研究杂志》
2014年第4期75-79,共5页
Journal of Medical Research
基金
中国医学科学院肿瘤医院院内临床研究课题(LC2007B31)
关键词
营养支持
低热量肠内营养
原发性肝癌
肝切除术
Nutrition support
Hypocaloric enteral nutrition
Primary liver cancer
Hepatectomy
