中华肝脏外科手术学电子杂志Issue(5)：306-310,5.DOI:10.3877/cma.j.issn.2095-3232.2015.05.012
早期肠内营养对重症肝炎肝移植患者术后恢复的影响
Effect of early enteral nutrition on recovery of patients with severe hepatitis after liver transplantation
摘要
Abstract
ObjectiveTo investigate the effects of early enteral nutrition on the recovery of patients with severe hepatitis after liver transplantation (LT).MethodsThirty-two patients with severe hepatitis undergoing allogeneic orthotopic LT in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and April 2014 were included in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were randomized into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Among the 14 patients in the enteral nutrition group, all patients were males with the average age of (42±9) years old. Among the 16 patients in the parenteral nutrition group, 14 were males and 2 were females with the average age of (44±10) years old. Patients in the enteral nutrition group were given warm water and lactulose through gastro-jejunal tube 1 d after LT. Enteral nutritional suspension was offered 2 d after LT and gradually increased to 1 000 ml/d, meanwhile, parenteral nutrition was reduced gradually. Patients in the parenteral nutrition group were given parenteral nutrition. Patients in both groups started normal diet after full recovery of the intestinal function. Venous blood was collected before LT and 1, 10 d after LT to examine hepatic and renal function. The recovery of gastroenteric function, hepatic and renal function and incidence of infection were observed 2 weeks after LT. The comparison of the observed indexes of two groups was conducted usingt test or rank-sum test and the rate comparison was conducted using Fisher's exact test.Results The postoperative recovery time of gastroenteric function of the enteral nutrition group was (6.1±1.4) d, which was significantly shorter than (10.6±3.8) of the parenteral nutrition group (t=-4.21,P<0.05). The median ALT, AST, TB, prealbumin and blood urea-nitrogen (BUN) in the enteral nutrition group 10 d after LT were respectively 106 (50-163) U/L, 62 (27-135) U/L, 67 (35-116) μmol/L, 201 (105-389) mg/L and 12.5 (6.4-18.8) mmol/L, and those in the parenteral nutrition group were respectively 276 (46-716) U/L, 119 (33-447) U/L, 131 (89-391) μmol/L, 162 (103-238) mg/L and 26.1(12.9-37.6) mmol/L. Signiifcant difference was observed (Z=-3.76,-3.15,-4.01, 2.93,-3.79;P<0.05). The incidence of infection of the enteral nutrition group 2 weeks after LT was 43% (6/14), which was signiifcantly lower than 69% (11/16) of the parenteral nutrition group (P<0.05). ConclusionCompared with parenteral nutrition, early enteral nutrition after LT may promote the recovery of gastroenteric function, improve the hepatic and renal function and nutritional situation and reduce the incidence of postoperative infection, which is beneficial to postoperative recovery.关键词
肠道营养/胃肠外营养/肝炎/肝移植/预后Key words
Enteral nutrition/Parenteral nutrition/Hepatitis/Liver transplantation/Prognosis引用本文复制引用
刘剑戎,易慧敏,许世磊,安玉玲,吕海金,易小猛,魏绪霞,熊亮,张英才,杨扬..早期肠内营养对重症肝炎肝移植患者术后恢复的影响[J].中华肝脏外科手术学电子杂志,2015,(5):306-310,5.基金项目
十二五国家科技重大专项（2012ZX100020100010）；国家自然科学基金（81170451，81170452，81300365，81370575）；广东省自然科学基金(9251008901000020)；广东省科技计划项目（2011B031800103）；广东省自然科学基金（S2013010016785）；广州市科技计划重大专项（11BppZLjj2060031）；广州市科技计划项目 （9251008901000020）
