中国实用外科杂志

中国实用外科杂志 ›› 2006, Vol. 26 ›› Issue (12): 1-951.

• 论著 •    

腹部手术后低氮低热量肠外营养对病人疗效及预后影响

吴国豪，张延伟，袁磊，林建华，吴肇汉   

  1. 复旦大学附属中山医院普外科，上海200032
  • 收稿日期:2006-09-05 修回日期:2006-10-25 出版日期:2007-01-17 发布日期:2007-01-17

The effect of hypocaloric and low nitrogen parenteral nutrition on outcome of surgical patients underwent abdominal operation.

Wu Guohao,Zhang Yanwei,Yuan Lei,et al.   

  1. Department of General Surgery,Zhongshan Hospital,Fu Dan University,Shanghai 200032，China
  • Received:2006-09-05 Revised:2006-10-25 Online:2007-01-17 Published:2007-01-17

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摘要：

目的:评价手术后低氮、低热量营养支持对外科大手术后病人疗效及预后的影响。方法:将2006年3～8月复旦大学附属中山医院普外科128例腹部中等程度以上手术病人随机分为研究组和对照组，研究组采用标准化肠外营养液（卡文）［平均摄入热量(76.98±17.57) kJ/(kg·d)，氮量(0.10±0.03) mol/(kg·d）］。对照组根据病人所测定的静息量消耗值［平均摄入热量(112.13±27.20) kJ/(kg·d)，氮量(0.24±0.06)mol/（kg·d）］，采用“全合一”方式配制3L袋，术后进行为期1周的肠外营养支持。比较两组病人血生化、营养状况、住院时间，以及术后当天至术后第28天的并发症。结果:两组研究结束时总蛋白、白蛋白、前白蛋白浓度均低于术前，两组间比较差异无显著性意义。研究组术后1周体重下降(4.4±2.6)kg，对照组体重下降(4.2±3.0)kg（P=0.137）。研究组血糖值升高的幅度及波动范围明显小于对照组，差异均有显著性意义。研究组8例(12.9%)27次使用胰岛素，平均胰岛素用量(4.6±3.2)U/次;对照组23例(34.8%)92次使用胰岛素，平均胰岛素用量(8.4±4.7) U/次,两组比较差异有显著性意义（P1=0.0047,P2=00051）。两组在并发症发生率及住院时间上，差异均无显著性意义（P1=0.143，P2=0.232）。结论:腹部术后低氮、低热量肠外营养比较传统肠外营养能更好控制术后血糖水平，其对营养疗效及临床预后的作用相同。

Abstract:

Objective:To assess the effect of hypocaloric and low nitrogen parenteral nutrition (PN) on the clinical outcome of patients underwent abdominal surgery. Methods:One hundred and twenty-eight patients underwent abdominal surgery between March 2006 and August 2006 in Zhongshan Hospital of Fu Dan University were divided into two groups randomizely.Study group (n=62) received calorie (76.98±17.57) kJ/(kg·d) and nitrogen (0.10±0.03)mol/(kg·d) using a standardized regimen （KabivenTMPI，Fresenius Kabi，Germany）.Control group (n=66) received calorie (112.13±27.20) kJ/(kg·d) and nitrogen (0.24±0.06)mol/(kg·d)in 3L bag.PN infused continuously for 7 days postoperatively.Biochemical indicators,nutritional status,hospital stay,complications from operative day to the postoperative 28th day were recorded to identify the difference between two groups.〖JP〗 Results:The concentrations of total protein,albumin,prealbumin in two groups in the end of study were lower than preoperative concentrations without significent differences between two groups.Weights in study group decreased (4.4±2.6)kg in postoperative 7 days,and weight in control group decreased (4.2±3.0)kg,(P=0.137).The growth of blood glucose level in study group was lower than that in control group with significent difference.Eight patients in study group received insulin for 27 times with (4.6±3.2)U of insulin every time.Twentythree patients in control group received insulin for 92 times with (8.4±4.7)U of sinsulin every time.There were significent differences between two groups,(P1=0.0047,P2=0.0051) There were no significant difference between two groups in the incidence of complications and hospital stay （P1=0.143,P2=0.232）. Conclusion:Hypocaloric and low nitrogen parenteral nutrition using standardised regimens can control postoperative blood glucose level better than traditional parenteral nutrition does.It has the same effectiveness in nutrition outcome and prognosis.