中国实用外科杂志2024，Vol.44Issue(2)：183-189,7.DOI:10.19538/j.cjps.issn1005-2208.2024.02.14
术前全肠外营养与肠内联合肠外营养对克罗恩病手术治疗效果影响的比较分析
Comparative analysis of preoperative total parenteral nutrition and enteral plus parenteral nutrition affecting the outcome of surgical treatment of Crohn's disease
摘要
Abstract
Objective To assess the impact of preoperative nutritional prehabilitation with total parenteral nutrition(TPN)versus enteral combined parenteral nutrition(EN+PN)on the outcomes of surgical patients with Crohn's disease(CD)complicated with intestinal obstruction or intestinal fistula.Methods The clinical data of 200 patients who underwent surgery after nutritional prehabilitation with TPN or EN+PN for CD combined with intestinal obstruction or intestinal fistula at the Inflammatory Bowel Disease Treatment Centre of General Surgery Department,Affiliated Hospital of Medical School,Nanjing University,from 2012-12-01 to 2021-12-01 were retrospectively analyzed.The patients were divided into the TPN group(137 cases)and,the EN+PN group(63 cases)according to the different ways of nutritional prehabilitation used.The propensity score matching(PSM)method was used to compare the effects of nutritional treatment and the incidence of complications at 30 d postoperatively between the TPN group and the EN+PN group.Results Before PSM,patients in the TPN and EN+PN groups had higher albumin levels and hemoglobin levels after nutritional pre-rehabilitation therapy compared with those before nutritional pre-rehabilitation therapy,and the albumin level in the EN+PN group was higher than that in the TPN group(35.7±4.4 g/L vs.33.5±5.4 g/L,t=-2.79,P=0.003);C-reactive protein in the EN+PN group was lower than that in the TPN group,but the difference was not statistically significant,6.3(1.1,20.5)mg/Lvs.9.9(2.3,30.0)mg/L,Z=-1.27,P=0.201;hemoglobin levels were higher in the EN+PN group than in the TPN group,112.5+15.5 g/L vs.105.3±18.8 g/L,t=-2.6,P=0.005.After PSM with hemoglobin and albumin as matching variables in a 1:2 ratio,there were 96 cases in the TPN group and 60 cases in the EN+PN group,respectively,and there was no statistically significant difference in the comparison of the albumin level and hemoglobin level between the two groups(both P＞0.05).After surgical treatment,the incidence of enterostomy(50.0％vs.30.0％,x2=6.1,P=0.022),superficial wound infection(27.1％vs.10.0％,x2=6.6,P=0.018),ileus(58.3％vs.33.3％,x2=9.2,P=0.004),and overall postoperative complications(70.8％vs.41.7％,x2=13.1,P=0.001)were higher in the TPN group compared with the EN+PN group.In addition,the TPN group had a longer hospital stay than the EN+PN group,11.0(7.0,16.0)d vs.8.0(6.7,11.0)d,Z=-2.4,P=0.013.Conclusions Both TPN and EN+PN can be used for nutritional prehabilitation and both can achieve satisfactory results,but nutritional prehabilitation with EN+PN may be better in terms of nutritional treatment effects and surgical outcomes,which deserves further research to validate.关键词
克罗恩病/全肠外营养/肠内营养/术后并发症/预康复Key words
Crohn's disease/total parenteral nutrition/enteral nutrition/postoperative complications,prehabilitation分类
医药卫生引用本文复制引用
孙振亚,宋天润,陈宇升,郭振,曹磊,李毅,朱维铭..术前全肠外营养与肠内联合肠外营养对克罗恩病手术治疗效果影响的比较分析[J].中国实用外科杂志,2024,44(2):183-189,7.基金项目
国家自然科学基金项目(No.82170573,No.81770556,No.82270543) （No.82170573,No.81770556,No.82270543）
