胰十二指肠切除术后早期肠内生态免疫营养对患者的影响

Effect of early enteral eco-immunonutrition therapy on patients after pancreaticoduodenectomy

摘要:

目的 探讨早期肠内生态免疫营养对胰十二指肠切除术后患者全身营养状况、术后并发症发生率及免疫功能的影响。方法 按纳入标准选择2019年1月至2022年12月在西安交通大学第一附属医院老年外科行胰十二指肠切除术患者，通过Excel自带程序简单随机分组，190 例患者完成研究，研究组和对照组各95 例。研究组术后第1天启动个性化肠内生态免疫营养，对照组给予以肠外营养为主的传统常规营养方案。检测各组术前、术后3、7、10、14 d血清白蛋白、前白蛋白、尿素、肌酐、血红蛋白、总胆固醇及淋巴细胞计数（比例），观察术中红细胞悬液、血浆使用量，术后通气时间、住院时间、药费及费用，住院药占比。分析两组之间术后并发症、上述指标差异，广义线性回归分析并发症相关因素。结果 发现术后并发症，研究组15例（15.79%），对照组36例（37.89%），两组之间存在统计学差异（χ²=12.095，P=0.001）。术后7、10 d 血清白蛋白水平，术后7、10、14 d 血清前白蛋白水平，术后10、14 d淋巴计数，术后7、10、14 d淋巴比例，术后3、10、14 d血红蛋白水平，术后10 d血清总胆固醇均明显高于对照组（均P<0.05）；广义线性回归分析显示术后并发症与女性、体质指数、营养评分、病毒性肝炎、通气时间、血浆输注量正相关、与营养治疗负相关。结论 给予胰十二指肠切除术后患者早期肠内生态免疫营养可显著改善患者营养状况，降低术后并发症发生，提高患者免疫功能。

Abstract:

Objective To investigate the effect of early enteral eco-immunonutrition therapy on the nutritional status，postoperative complication，and immune function of patients after pancreatoduodenectomy.Methods A total of 190 patients who underwent pancreatoduodenectomy in Department of Geriatric Surgery，The First Affiliated Hospital of Xi’an Jiaotong University，from January 2019 to December 2022 were enrolled according to the inclusion criteria，and they were randomly divided into study group and control group using the method of simple random grouping in Excel. All 190 patients completed the study，with 95 patients in the study group and 95 patients in the control group. The patients in the study group received individualized enteral eco-immunonutrition therapy since day 1 after surgery，and those in the control group were given conventional nutrition，mainly parenteral nutrition. Related indices were measured before surgery and on days 3，7，10，and 14 after surgery，including serum albumin，pre albumin，urea，creatinine，hemoglobin，total cholesterol，and lymphocyte count（percentage），and the two groups were observed in terms of the amount of red cell suspension and plasma used during surgery，duration of postoperative ventilation，length of hospital stay，drug and in-hospital expenditure，and the total percentage of drug expenditure in hospital. Postoperative complications and the differences in the above indicators were analyzed for the two groups，and a generalized linear regression analysis was used to investigate the factors associated with complications.Results There was a significant difference in the incidence rate of postoperative complications between the study group and the control group［15 cases（15.79%） vs. 36 cases（37.89%），χ²=12.095，P=0.001）. Compared with the control group，the study group had a significantly higher serum albumin level on days 7 and 10 after surgery，a significantly higher serum prealbumin level on days 7，10，and 14 after surgery，a significantly higher lymphocyte count on days 10 and 14 after surgery，a significantly higher percentage of lymphocytes on days 7，10，and 14 after surgery，a significantly higher hemoglobin level on days 3，10，and 14 after surgery，and a significantly higher serum level of total cholesterol on day 10 after surgery（all P<0.05）. The generalized linear regression analysis showed that postoperative complications were positively correlated with female sex，body mass index，international nutrition score，viral hepatitis，length of postoperative ventilation，and amount of plasma transfusion，while postoperative complications were negatively correlated with nutritional therapy.Conclusion Early enteral eco-immunonutrition therapy for patients after pancreatoduodenectomy can significantly improve their nutritional status，reduce the incidence rate of postoperative complications，and enhance their immune function.