消化液回输治疗小肠中断病人的疗效分析
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摘要
目的:回顾性分析消化液回输在小肠中断病人中的治疗效果。方法:收集空军军医大学西京医院消化外科2015年7月至2017年7月使用消化液回输泵治疗肠道连续性中断的30例病人病例资料,比较回输前与回输后4周血清白蛋白(ALB)、外周血总淋巴细胞计数(TLC)、预后营养指数[PNI=淋巴细胞绝对值(10~9/L)×5+血清白蛋白(g/L)]、体质指数(BMI)等营养指标以及回输前与回输后10天消化液丢失量、静脉液体量和经口进食量等指标。结果:回输4周后,ALB为[(32.9±4.7)vs(38.9±3.8)]g/L,P <0.001;TLC为[(1.3±0.3)vs(1.8±0.4)]×10~9/L,P <0.05;PNI为[(39.5±5.1) vs (47.9±4.7)],P <0.001;BMI为[(21.4±3.5)vs(22.1±2.9)]kg/m~2,P <0.05。回输10 d后,消化液丢失量[(1 374.7±837.4)vs (0)]mL/d,P <0.001;静脉液体量[(1 641.1±677.5) vs (1 151.7±553.5)] mL/d, P <0.05;经口进食量[(297.6±385.1)vs (610.6±381.4)]mL/d, P <0.001。肠内营养达到目标量平均时间(13.60±6.06)d,肠内营养平均用量(1 005.45±533.84)mL/d。营养指标ALB、PNI、TLC、BMI均显著升高;消化液丢失量、静脉液体量显著减少,经口进食量增加。结论:消化液回输泵回输消化液能显著改善肠道连续性中断病人营养状况,促进肠道吸收功能恢复,减少消化液丢失量和静脉输液量,增加经口进食量。
Objective: Retrospective analysis of the effect of digestive juice reinfusion in patients with small intestine interruption. Methods: Thirty patients of discontinuous of intestinal tract which all used chyme reinfusion pump from July 2015 to July 2017 Digestive Hospital of Xijing Hospital of Air Force Military Medical University were enrolled in the study.Serum albumin(ALB), peripheral blood total lymphocyte count(TLC), prognosis nutritional index [PNI=absolute value of lymphocyte(10~9/L) ×5 + serum albumin(g/L)] and body mass index(BMI) before and after 4 weeks of chyme reinfusion were determined. Loss of digestive juice, venous fluid volume and oral intake before and after 10 days of chyme reinfusion were calculated. Results: As compared to pre-reinfusion, ALB[(32.9 ± 4.7)vs(38.9 ±3.8)] g/L, P < 0.001; TLC([1.3 ± 0.3)vs(1.8 ± 0.4)] ×10~9/L, P < 0.05; PNI [(39.5 ± 5.1) vs(47.9 ± 4.7)], P < 0.001; BMI[(21.4 ± 3.5)vs(22.1 ± 2.9)] kg/m~2, P < 0.05. After 10 days compared to pre-reinfusion, loss of digestive juice [(1374.7 ± 837.4)vs(0)] mL/d, P < 0.001; Venous fluid volume [(1 641.1 ± 677.5) vs(1 151.7 ± 553.5)] mL/d, P < 0.05]; Oral intake [(297.6 ± 385.1)vs(610.6 ± 381.4)] mL/d, P < 0.001, The average time of enteral nutrition to reach the target is(13.60 ± 6.06)d; Average amount of enteral nutrition is(1005.45 ± 533.84)mL/d. Nutritional indexes of ALB, PNI, TLC and BMI all increased. Loss of digestive juice and venous fluid volume dramatically reduce, Oral intake significantly increased. Conclusions: Digestive juice reinfusion can apparently improve the nutritional status and intestinal absorption function of patients with small intestine interruption because of reduce of loss of digestive juice and venous fluid volume and increase of oral intake.
Objective: Retrospective analysis of the effect of digestive juice reinfusion in patients with small intestine interruption. Methods: Thirty patients of discontinuous of intestinal tract which all used chyme reinfusion pump from July 2015 to July 2017 Digestive Hospital of Xijing Hospital of Air Force Military Medical University were enrolled in the study.Serum albumin(ALB), peripheral blood total lymphocyte count(TLC), prognosis nutritional index [PNI=absolute value of lymphocyte(10~9/L) ×5 + serum albumin(g/L)] and body mass index(BMI) before and after 4 weeks of chyme reinfusion were determined. Loss of digestive juice, venous fluid volume and oral intake before and after 10 days of chyme reinfusion were calculated. Results: As compared to pre-reinfusion, ALB[(32.9 ± 4.7)vs(38.9 ±3.8)] g/L, P < 0.001; TLC([1.3 ± 0.3)vs(1.8 ± 0.4)] ×10~9/L, P < 0.05; PNI [(39.5 ± 5.1) vs(47.9 ± 4.7)], P < 0.001; BMI[(21.4 ± 3.5)vs(22.1 ± 2.9)] kg/m~2, P < 0.05. After 10 days compared to pre-reinfusion, loss of digestive juice [(1374.7 ± 837.4)vs(0)] mL/d, P < 0.001; Venous fluid volume [(1 641.1 ± 677.5) vs(1 151.7 ± 553.5)] mL/d, P < 0.05]; Oral intake [(297.6 ± 385.1)vs(610.6 ± 381.4)] mL/d, P < 0.001, The average time of enteral nutrition to reach the target is(13.60 ± 6.06)d; Average amount of enteral nutrition is(1005.45 ± 533.84)mL/d. Nutritional indexes of ALB, PNI, TLC and BMI all increased. Loss of digestive juice and venous fluid volume dramatically reduce, Oral intake significantly increased. Conclusions: Digestive juice reinfusion can apparently improve the nutritional status and intestinal absorption function of patients with small intestine interruption because of reduce of loss of digestive juice and venous fluid volume and increase of oral intake.
引文
[1]Calicis B,Parc Y,Caplin S,et al.Treatment of postoperative peritonitis of small-bowel origin with continuous enteral nutrition and succus entericus reinfusion.Arch Surg,2002,137(3):296-300.
[2]吴琳珊,华宏妹.旷置性肠管的临床特点与护理进展.护理与康复,2017,16(1):28-30.
[3]朱晋国,任建安,王新波,等.肠液回输对肠外瘘病人肠内营养物质吸收的影响.中华普通外科杂志,2006,21(10):724-726.
[4]Rubinsky MD,Clark AP.Early enteral nutrition in critically ill patients.Dimens Crit Care Nurs,2012,31(5):267-274.
[5]赵青川,李旭照,李晓华,等.肠瘘并发复杂腹腔感染外科三级防治策略.中华胃肠外科杂志,2017,20(3):251-254.
[6]董琦,林海,李权,等.肠液回输在婴幼儿小肠造瘘术后的应用.实用医学杂志,2012,28(8):1383-1384.
[7]黎介寿.首选肠内营养的合理性.肠外与肠内营养,2013,20(6):321-323.
[8]Thibault R,Picot D.Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula.Curr Opin Clin Nutr Metab Care,2016,19.
[9]Lévy E,Palmer DL,Frileux P,et al.Inhibition of upper gastrointestinal secretions by reinfusion of succus entericus into the distal small bowel.A clinical study of 30 patients with peritonitis and temporary enterostomy.Ann Surg,1983,198(5):596-600.
[10]朱晋国,王健,和源,等.小肠双造口和肠液回输在重度腹腔感染病人的应用.中华胃肠外科杂志,2015(7):667-670.
[11]Yuan Y,Ren J,Gu G,et al.Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis.Nutr Clin Pract,2011,26(6):688-694.
[12]陈焕,蒋维维,路长贵,等.肠液回输对新生儿小肠造瘘术后的加速康复作用.南京医科大学学报(自然科学版),2017(7):872-875.
[13]Coetzee E,Rahim Z,Boutall A,et al.Refeeding enteroclysis as an alternative to parenteral nutrition for enteric fistula.Colorectal Dis,2014,16(10):823-830.
[14]Teubner A,Morrison K,Ravishankar H R,et al.Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula.Br J Surg,2004,91(5):625-631.
[15]朱晋国,于仁,葛恒发,等.肠液回输对肠外瘘病人小肠黏膜屏障功能的影响.中华临床营养杂志,2011,19(4):239-241.
[16]洪书剑,顾国胜,任建安,等.肠内营养对长期禁食肠瘘病人肠黏膜上皮内淋巴细胞及黏液屏障功能的研究.中华胃肠外科杂志,2006,28(6):527-529.
[17]叶向红,江方正,彭南海,等.重症肠瘘病人早期肠内营养结合消化液回输的管理.肠外与肠内营养,2014,21(3):189-192.
[18]Picot D,Garin L,Trivin F,et al.Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.Clinical Nutrition,2010,29(2):235-242.
[19]Picot D,Layec S,Dussaulx L,et al.Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy:A 15-year prospective cohort in a referral centre.Clin Nutr,2017,36(2):593-600.
[2]吴琳珊,华宏妹.旷置性肠管的临床特点与护理进展.护理与康复,2017,16(1):28-30.
[3]朱晋国,任建安,王新波,等.肠液回输对肠外瘘病人肠内营养物质吸收的影响.中华普通外科杂志,2006,21(10):724-726.
[4]Rubinsky MD,Clark AP.Early enteral nutrition in critically ill patients.Dimens Crit Care Nurs,2012,31(5):267-274.
[5]赵青川,李旭照,李晓华,等.肠瘘并发复杂腹腔感染外科三级防治策略.中华胃肠外科杂志,2017,20(3):251-254.
[6]董琦,林海,李权,等.肠液回输在婴幼儿小肠造瘘术后的应用.实用医学杂志,2012,28(8):1383-1384.
[7]黎介寿.首选肠内营养的合理性.肠外与肠内营养,2013,20(6):321-323.
[8]Thibault R,Picot D.Chyme reinfusion or enteroclysis in nutrition of patients with temporary double enterostomy or enterocutaneous fistula.Curr Opin Clin Nutr Metab Care,2016,19.
[9]Lévy E,Palmer DL,Frileux P,et al.Inhibition of upper gastrointestinal secretions by reinfusion of succus entericus into the distal small bowel.A clinical study of 30 patients with peritonitis and temporary enterostomy.Ann Surg,1983,198(5):596-600.
[10]朱晋国,王健,和源,等.小肠双造口和肠液回输在重度腹腔感染病人的应用.中华胃肠外科杂志,2015(7):667-670.
[11]Yuan Y,Ren J,Gu G,et al.Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complicated with severe sepsis.Nutr Clin Pract,2011,26(6):688-694.
[12]陈焕,蒋维维,路长贵,等.肠液回输对新生儿小肠造瘘术后的加速康复作用.南京医科大学学报(自然科学版),2017(7):872-875.
[13]Coetzee E,Rahim Z,Boutall A,et al.Refeeding enteroclysis as an alternative to parenteral nutrition for enteric fistula.Colorectal Dis,2014,16(10):823-830.
[14]Teubner A,Morrison K,Ravishankar H R,et al.Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula.Br J Surg,2004,91(5):625-631.
[15]朱晋国,于仁,葛恒发,等.肠液回输对肠外瘘病人小肠黏膜屏障功能的影响.中华临床营养杂志,2011,19(4):239-241.
[16]洪书剑,顾国胜,任建安,等.肠内营养对长期禁食肠瘘病人肠黏膜上皮内淋巴细胞及黏液屏障功能的研究.中华胃肠外科杂志,2006,28(6):527-529.
[17]叶向红,江方正,彭南海,等.重症肠瘘病人早期肠内营养结合消化液回输的管理.肠外与肠内营养,2014,21(3):189-192.
[18]Picot D,Garin L,Trivin F,et al.Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.Clinical Nutrition,2010,29(2):235-242.
[19]Picot D,Layec S,Dussaulx L,et al.Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy:A 15-year prospective cohort in a referral centre.Clin Nutr,2017,36(2):593-600.