| 张剑琴,杨刚华,孟凡迪,等.早期肠内生态免疫营养对老年腹部术后病人的影响[J].安徽医药,2019,23(10):2036-2040. |
| 早期肠内生态免疫营养对老年腹部术后病人的影响 |
| Effect of early enteral eco?immunonutrition therapy on elder patients undergoing abdominal operation |
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| DOI：10.3969/j.issn.1009?6469.2019.10.033 |
| 中文关键词: 肠道营养 消化系统外科手术 前白蛋白 淋巴细胞计数 肠内生态免疫营养 老年人 |
| 英文关键词: Enteral nutrition Digestive system surgical procedures Prealbumin Lymphocyte count Enteral eco?immuno nutrition Aged |
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| 中文摘要: |
| 目的探讨早期肠内生态免疫营养治疗对老年腹部术后病人全身营养状态、术后并发症发生率及免疫功能的影响。方法按纳入标准共选择 2016年 1月至 2017年 12月在西安交通大学第一附属医院老年外科行腹部手术的老年病人 85例，其中行胰十二指肠切除术 36例，胃空肠吻合术 25例，胃癌根治术 11例，结肠癌根治术 6例，其他手术 7例。通过 Excel自带程序随机分组法分为研究组和对照组。研究组 40例，对照组 45例。研究组于术后第 1天开始启动个性化肠内生态免疫营养治疗，对照组传统常规肠内营养处理。两组均查术前、术后 3、7、14 d血清白蛋白、前白蛋白、尿素、肌酐、血红蛋白及淋巴细胞计数(比例)，观察术后通气时间、白蛋白使用量、住院时间、药占比。分析两组之间术后并发症、上述指标差异及治疗与术后并发症相关因素。结果研究组发生术后并发症 3例( 7.5%)对照组 14例( 31.1%)，两者差异有统计学意义( χ2＝7.378，P＝0.007)logistic多因素相关分析提示术后并发症发生与治疗呈负相，关( OR＝0.212，95%CI:0.055~0.809，P＝0.023)。术后 3d研究组尿素，氮水平低于对照组(P＝0.016)；研究组血清前白蛋白水平在术后 3d、7d、14 d均高于对照组(分别为 P＝0.023，0.019，＜0.001)；术后 3d、14 d研究组淋巴细胞计数高于对照组(分别为 P＝0.026，P＜0.001)，且14 d研究组淋巴细胞比例高于对照组(P＜0.001)；术后 3d、14 d研究组血红蛋白水平高于对照组(分别为 P＝0.006；P＜0.001)；研究组病人术后通气时间早于对照组(P＜0.001)白蛋白使用量少于对照组( P＝0.013)，住院时间短于对照组( P＝0.027)；药占比两组之间差异无统计学意义( P＝0.406)。结论， |
| 英文摘要: |
| Objective To investigate the effects of early enteral eco?immunonutrition therapy on the nutritional status，postoperativecomplications and immune function of the elderly patients undergoing abdominal operation.Methods Eighty?five elderly patients undergoing the abdominal operation in The First Affiliated Hospital of Xi’an Jiaotong University from January 2016 to December 2017 were selected according to the inclusion criteria，，including 36 cases undergoing pancreaticoduodenectomy，25 cases of gastro? jejunostomy，11 cases of radical gastrectomy，6 cases of colon cancer radical surgery，and 7 cases of other operations.Patients were assigned into study group(40 cases)and control group(45 cases)randomly by the method of random grouping of excel own?bandprogram.The patients in study group were given enteral nutrition on the first day after operation，and were gradually given individu?alized enteral ecological immune nutrition preparation.The patients in control group were given enteral nutrition routinely.Serum al?bumin，pre albumin，urea，creatinine，hemoglobin and lymphocyte count(ratio)were checked before operation and on 3 d，7d，14 d after operation.Duration of ventilation，albumin usage，length of stay，and the percentage of drug expenditure after operation were ob? served in the two groups.The postoperative complications，the differences of the above indicators and the related factors of treatment and postoperative complications were analyzed.Results Postoperative complications in the study group(3 cases，7.5%)were statis? tically lower than that in the control group(14 cases，31.1%)( χ2＝7.378，P＝0.007)； logistic regression showed that there was sta? tistically negative correlation between the postoperative complications and treatment(OR＝0.212，95%CI:0.055?0.809，P＝0.023). The level of urea nitrogen in the study group was lower than that in the control group at 3 days after operation(P＝0.016).Serum pre albumin levels in the study group were statistically higher than in the control group at d3，d7 and d14 after operation(P＝ 0.023，0.019，P＜0.001，respectively).Lymphocyte count in the study group was statistically higher than in the control group at d3 and d14 after operation(P＝0.026 and P＜0.001，respectively).The proportion of lymphocytes in the study group was statistically higher than that in the control group at d14 after operation(P＜0.001).The hemoglobin level of the study group was higher than that of the control group at d3 and d14 after operation(P＝0.006 and P＜0.001，respectively).The postoperative ventilation time of the study group was earlier than that of the control group(P＜0.001)； the albumin usage of the study group was less than that of the control group(P＝0.013)； the hospital stay of the study group was shorter than that of the control group(P＝0.027)； there was no significant difference in the percentage of drug expenditure between the two groups(P＝0.406).Conclusion The early enteral eco?immunonutrition therapy for the elderly patients can significantly improve the nutritional status，reduce the complications，and improve the body’s immune function. |
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