食管癌手术后肠内营养与肠外营养对肝、肾功能及胃肠功能影响的对比研究

目的探讨食管癌手术后肠内营养与肠外营养两种不同的营养方式对手术后患者肝功能、肾功能及胃肠功能的影响。方法回顾性分析2012年1月至2013年8月广东医学院附属医院124例食管癌手术后患者的临床资料,其中男71例、女53例,年龄31~85岁,平均年龄59.7岁。应用抽签法将124例患者随机分成试验组和对照组。试验组：术后采用经鼻肠管＋胃管行肠内营养,对照组：术后采取静脉滴注营养液。于术前、术后第1 d、第3 d、第7 d晨起未输液前检测外周静脉血丙氨酸转移酶、天冬氨酸转移酶、间接胆红素、直接胆红素、总胆红素、总蛋白、白蛋白等肝功能指标,检测尿素氮、血肌酐等肾功能指标,以及术后肠鸣音恢复时间、第一次排气时间、第一次排便时间等胃肠功能恢复指标。结果肝功能主要指标中丙氨酸转移酶、天冬氨酸转移酶、间接胆红素、直接胆红素、总胆红素术前及术后第1d两组间差异无统计学意义（P〉0.05）,术后第3 d及第7 d试验组低于对照组（P〈0.05）;总蛋白、白蛋白等指标两组差异均无统计学意义（P〉0.05）。试验组患者静脉血尿素氮、肌酐等肾功能指标术前、术后第1d、第3d与对照组比较差异均无统计学意义（P〉0.05）,术后第7 d试验组低于对照组术后第7 d试验组与对照组尿素氮比较：（4.94±1.07）mmol/L vs.（6.67±2.88）mmol/L;术后第7 d试验组与对照组肌酐比较：（52.50±12.46）μmol/L vs.（68.23±7.61）μmol/L;P〈0.05]。试验组术后肠鸣音恢复时间（42.00±1.68）h vs.（50.00±1.54）h]、第一次排气时间（64.15±10.35）h vs.（70.64±14.73）h]、第一次排便时间（4.20±1.50）d vs.（5.20±1.40）d]等胃肠功能指标较对照组明显缩短（P〈0.05）。结论食管癌手术后肠内营养能促进胃肠功能恢复,对肝、肾功能影响较小,有利于患者术后恢复,减少并发症的发生。

Comparison of the Influence of Enteral Nutrition and Total Parenteral Nutrition on Liver,Kidney and Gastrointestinal Function in Patients after Esophagectomy

Objective To investigate the influence of enteral nutrition （EN） and total parenteral nutrition （TPN） on liver, kidney and gastrointestinal function in patients after esophagectomy. Methods A total of 124 patients with esophageal cancer who underwent esophagectomy in the Affiliated Hospital of Guangdong Medical College from January 2012 to August 2013 were enrolled in this study. There were 71 male and 53 female patients with their average age of 59.7 years （range 31 to 85 years）. All the patients were randomly divided into an experimental group and a control group. Postoperatively, patients in the experimental group received EN via nasogastric/nasointestinal tube, and patients in the control group received TPN. Preoperatively, 1,3 and 7 days postoperatively, plasma alanine transaminase （ALT）, aspartate transaminase （AST）, indirect bilirubin （I_BIL）, direct bilirubin （ DB ）, total bilirubin （ TB ）, total protein （ TP ） and albumin （ALB） were examined to evaluate liver function, blood urea nitrogen （BUN） and serum creatinine （Scr） were examined to evaluate renal function. Postoperative time to first audible bowel sounds, time to first flatus, and time to first stool were examined to evaluate gastrointestinal function. Results There was no statistical difference in ALT, AST, I_BIL, DB or TB preoperatively and on the 1st postoperative day between the 2 groups （P 〉 0.05 ） ,but these parameters of the experimental group were significantly lower than those of the control group on the 3rd and 7th postoperative day （P 〈 0.05 ）. There was no statistical difference in TP or ALB between the 2 groups （P 〉 0.05 ）. There was no statistical difference in BUN or Scr preoperatively, on the 1 st or 3rd postoperative day between the 2 groups （P 〉 0.05 ）. BUN （4.9± 1.07 mmol/L vs. 6.67± 2.88 mmol/L,P 〈 0.05 ） and Scr （ 52.50±12.46 btmol/L vs. 68.23 ± 7.61 μmol/L,P 〈 0.05 ） of the experimental group were significantly lower than those of the cont