惡性阻塞性黃疸術(shù)后早期腸內(nèi)營(yíng)養(yǎng)對(duì)肝腎功能的影響

曹英志 張麗萍

【摘要】研究惡性阻塞性黃疸手術(shù)后早期腸內(nèi)營(yíng)養(yǎng)支持（EEN）與全腸外營(yíng)養(yǎng)支持（TPN）對(duì)肝、腎功能的影響。方法 將36例惡性阻塞性黃疸病人術(shù)后隨機(jī)分為EEN組（16例）和TPN組（20例），均于術(shù)后第2d（48h內(nèi)）開(kāi)始進(jìn)行營(yíng)養(yǎng)支持，EEN液經(jīng)空腸造口管以腸內(nèi)營(yíng)養(yǎng)輸注泵滴入，TPN液經(jīng)深靜脈置管滴入。術(shù)前及術(shù)后第5、7d監(jiān)測(cè)肝、腎功能，進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果 肝功能檢測(cè)值EEN組恢復(fù)速度較TPN組快，其中血總膽紅素（TB）和r-谷氨酰轉(zhuǎn)肽酶（r-GT）于術(shù)后第7d時(shí)兩組差異有統(tǒng)計(jì)學(xué)意義。腎功能檢測(cè)值EEN組術(shù)后升高幅度較TPN組低、恢復(fù)較快，其中尿轉(zhuǎn)鐵蛋白（TRF）、N-2酰-β-D-氨基葡萄苷酶（NAG）、α-微球蛋白（α1-mG）于術(shù)后第7d兩組差異有統(tǒng)計(jì)學(xué)意義。結(jié)論 早期腸內(nèi)營(yíng)養(yǎng)支持在促進(jìn)惡性阻塞性黃疸術(shù)后肝、腎功能恢復(fù)方面優(yōu)于全腸外營(yíng)養(yǎng)支持。

【關(guān)鍵詞】早期腸內(nèi)營(yíng)養(yǎng)；阻塞性黃疸；肝腎功能

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

惡性阻塞性黃疸病人長(zhǎng)期，慢性的膽道梗阻，膽汁淤積，膽道感染，同時(shí)腸道膽鹽缺乏使腸道菌群失調(diào)，腸淋巴系統(tǒng)及腸黏膜萎縮，導(dǎo)致腸屏障破壞，通透性增高，腸道內(nèi)大量的細(xì)菌及內(nèi)毒素易進(jìn)入靜脈系統(tǒng)，造成肝功能損害。由于全身免疫系統(tǒng)失調(diào)，從而腸源性內(nèi)毒素進(jìn)入體循環(huán)，導(dǎo)致內(nèi)毒素血癥，造成組織器官損傷，尤其是腎損傷。此外，惡性梗阻黃疸病人的抹，麻醉時(shí)間長(zhǎng)，手術(shù)創(chuàng)傷大，術(shù)后應(yīng)激反應(yīng)重，極易并發(fā)或加重內(nèi)毒素血癥【1、2】。早期腸內(nèi)營(yíng)養(yǎng)支持（EEN）較全腸外營(yíng)養(yǎng)支持（TPN）具有并發(fā)癥少和保護(hù)器官功能等優(yōu)勢(shì)。本文都對(duì)惡性阻塞性黃疸術(shù)后EEN與TPN對(duì)肝、腎功能的影響做一前瞻性研究?！?br>