等差递增肠内营养对肝门部胆管癌患者营养状况及喂养耐受性的影响

doi:10.3969/j.issn.2095-1264.2024.01.19

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等差递增肠内营养对肝门部胆管癌患者营养状况及喂养耐受性的影响
DOI:
                        10.3969/j.issn.2095-1264.2024.01.19
                    
作者:
                        
                        
                    
作者单位:梧州市中医医院 营养科，广西 梧州，543002
作者简介:张武爱，女，副主任护师，研究方向：糖尿病营养、肿瘤营养等。
通讯作者:王展福，男，硕士，主任医师，研究方向：胃肠肿瘤。
中图分类号:R735.8;R473.73
基金项目:

Effect of iso-incremental enteral nutrition infusion on the nutritional status and feeding tolerance of patients with hilar cholangiocarcinoma

Author:

Affiliation:

Nutritional Department, Wuzhou Municipal Hospital of Traditional Chinese Medicine, Wuzhou, 543002, Guangxi, China

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摘要:

目的研究等差递增肠内营养对肝门部胆管癌患者营养状况及喂养耐受性的影响。方法选择我院收治的80例肝门部胆管癌术后患者，入组时间为2018年2月—2020年3月，所有患者分组方式为随机抽签法。其中40例为参照组，予以间歇推注法开展肠内营养支持；40例为观察组，肠内营养支持方式为等差递增输注法。参照组及观察组平均营养支持干预时间为10 d。分别于术前1 d、术后10 d检测两组患者营养状态指标前白蛋白、转铁蛋白、白蛋白水平；对两组患者采用早期肠内营养（EEN）喂养耐受性问卷调查表进行评价；检测患者术前1 d、术后10 d免疫功能指标CD4⁺、CD8⁺水平，计算CD4⁺/CD8⁺比值；术后观察参照组及观察组患者并发症发生情况。结果术前1 d，参照组及观察组营养状态指标前白蛋白、转铁蛋白、白蛋白水平相比无显著差异（P>0.05）；术后10 d，观察组前白蛋白、转铁蛋白、白蛋白水平明显高于参照组（P<0.05）。观察组与参照组在EEN总耐受率方面对比，前者更高（P<0.05）。术前1 d，观察组与参照组免疫状态指标CD4⁺、CD8⁺、CD4⁺/CD8⁺无明显差异（P>0.05）；术后10 d，观察组CD8⁺水平相比参照组明显更低，而CD4⁺/CD8⁺相比参照组明显更高（P<0.05）。观察组与参照组腹腔感染发生率对比，前者更低（P<0.05）。结论给予肝门部胆管癌患者等差递增肠内营养输注，可改善患者营养状况，提高EEN喂养耐受性，增强免疫功能，降低腹腔感染的发生风险，值得临床推广应用。

Abstract:

Objective To investigate the effect of iso-incremental enteral nutrition infusion on the nutritional status and early enteral nutrition (EEN) feeding tolerance of hilar cholangiocarcinoma patients.Methods A total of 80 postoperative patients with hilar cholangiocarcinoma treated in our hospital between February 2018 and March 2020 were selected, and were randomly divided into two groups. 40 cases in the reference group got enteral nutrition support with intermittent infusion method, and 40 cases in the observation group got enteral nutrition support with the iso-incremental infusion method. The intervention time of nutritional support for both groups was averagely 10 d. The levels of nutritional status indicators such as prealbumin, transferrin, albumin of patients in both groups were detected 1 d before and 10 d after surgery. The EEN feeding tolerance questionnaire of patients in both groups was evaluated. The complications of both groups were observed after operation.Results There were no differences in the levels of prealbumin, transferrin, and albumin between the reference group and the observation group 1 d before surgery (P>0.05). However, 10 d after surgery, the levels of prealbumin, transferrin, and albumin were significantly higher in the observation group than in the reference group (P<0.05). The total tolerance rate of EEN in the observation group was higher than in the reference group (P<0.05). There were no differences in immune status indexes of CD4⁺, CD8⁺, and CD4⁺/CD8⁺between the two groups at 1 d before surgery (P>0.05). However, 10 d after surgery, the level of CD8⁺ in the observation group was significantly lower than in the reference group, while the CD4⁺/CD8⁺ was significantly higher than in the reference group (P<0.05). The incidence of intraperitoneal infection in the observation group was significantly lower than in the reference group (P<0.05).Conclusion Iso-incremental enteral nutrition infusion is worthy of clinical application in patients with hilar cholangiocarcinoma, for it can improve the nutritional status, increase the EEN feeding tolerance, enhance the immune function, and reduce the risk of abdominal infection of patients.