【摘要】 目的探讨不同营养支持方式对肠破裂修补术后合并腹腔感染患者肠黏膜屏障以及脏器功能的影响。方法将126例肠破裂修补术后合并腹腔感染患者随机分为3组,每组42例。完全组给予完全肠内营养,低量组给予低热量肠内营养,结合组给予低热量肠内营养+肠外营养,观察3组治疗前及治疗后第5天血浆总蛋白、白蛋白、前白蛋白、谷草转氨酶、肌酐、胱抑素C水平及术后第1,3,5天血清中二胺氧化酶与内毒素水平,统计3组治疗过程中恶心、呕吐、胃潴留、腹胀发生率。结果治疗后第5天,完全组血浆总蛋白、白蛋白、前白蛋白水平均明显低于其他2组(P均<0.05),谷草转氨酶、血肌酐、胱抑素C水平明显高于其他2组(P均<0.05);低量组谷草转氨酶、血肌酐、胱抑素C水平与结合组比较无明显差异(P均>0.05),但结合组血浆总蛋白、白蛋白、前白蛋白水平均明显高于低量组(P均<0.05)。治疗后3组二胺氧化酶与内毒素水平呈逐渐下降趋势,完全组下降幅度明显小于其他2组(P均<0.05),低量组与结合组下降幅度比较差异均无统计学意义(P均>0.05)。完全组恶心、呕吐、胃潴留、腹胀发生率均明显高于其他2组(P均<0.05),低量组各指标与结合组比较差异均无统计学意义(P均>0.05)。结论早期低热量肠内营养+肠外营养结合支持方式可明显提高血浆蛋白水平,保护肠黏膜屏障结构,防治继发性脏器功能损伤,最大限度减少胃肠食物不耐受症状。更多还原

【Abstract】 Objective It is to investigate the effect of early enteral nutrition support on the protection of intestinal mucosal barrier and organ function in patients with intestinal rupture neoplasty with complicated with abdominal infection. Methods126 patients with intestinal rupture complicated with abdominal infection were randomly divided into the total enteral nutrition group( complete group),low calorie enteral nutrition group( low dose group) and enteral and parenteral nutrition( combination group) which had each forty-two patients. The levels of plasma total protein,pre-albumin,aspartate transminase,creatinine and cystatin C were observed on the 5th day after treatment and before treatment. The incidence rate of nausea,vomiting,gastric retention,abdominal distension,diarrhea and intra-abdominal pressure were compared among three groups during the treatment.The levels of two amine oxidase and endotoxin were measured on the 1st,third,5th day. the difference of intestinal mucosal barrier function among the three groups were compared. Results Before treatment,there was no significant difference in age,gender,body mass index,the cause of intertinal rupture injury,infection and acute physiology and chronic health status among three groups. On the 5th day after treatment,the levels of plasma total protein,pre-albumin in total renteral nutrition group decreased more than the other groups,the level of aspartate transminase,creatinine and cystatin C were clearly on the rise,the difference was statistically significant. the level of aspartate transminase,creatinine and cystatin C between low dose group and combination group was not statistically significant,but the level of plasma total protein,albumin and pre albumin in the low dose group was below the combined group,the difference was statistically significant. The incidence rate of nausea,vomiting,gastric retention,abdominal distension,diarrhea and intra-abdominal high pressure were highest and the two amine oxidase and endotoxin was lowest in the combination group. the difference among three groups was statistically significant. Conclusion Early low calorie enteral nutrition and parenteral nutrition can significantly improve plasma protein level,protect the structure of intestinal mucosal barrier,prevent secondary organ damage and minimize gastrointestinal food intolerance synndrome.更多还原