Hu Qing-Gang, Zheng Qi-Chang
Department of Surgery, Xiehe hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province China.
World J Gastroenterol. 2003 Apr;9(4):843-6. doi: 10.3748/wjg.v9.i4.843.
To investigate the safety, rationality and the practicality of enteral nutritional (EN) support in the postoperative patients with damaged liver function and the protective effect of EN on the gut barrier.
135 patients with liver function of Child B or C grade were randomly allocated to enteral nutrition group (EN, 65 cases), total parenteral nutrition group (TPN, 40 cases) and control group (CON, 30 cases). Nutritional parameters, hepatic and kidney function indexes were measured at the day before operation, 5th and 10th day after the operation respectively. Comparison was made to evaluate the efficacy of different nutritional support. Urinary concentrations of lactulose(L) and mannitol(M) were measured by pulsed electrochemical detection(HPLC-PED) and the L/M ratio calculated to evaluate their effectiveness on protection of gut barrier.
No significant damages in hepatic and kidney function were observed in both EN and TPN groups between pre- and postoperatively. EN group was the earliest one reaching the positive nitrogen balance after operation and with the lowest loss of body weight and there was no change in L/M ratio after the operation (0.026+/-0.004) at the day 1 before operation, 0.030+/-0.004 at the day 5 postoperative and 0.027+/-0.005 at the day 10 postoperative), but the change in TPN group was significant at the day 5 postoperative (0.027+/-0.003 vs 0.038+/-0.009,P<0.01).
EN is a rational and effective method in patients with hepatic dysfunction after operation and has significant protection effect on the gut barrier.
探讨肠内营养（EN）支持在肝功能受损的术后患者中的安全性、合理性和实用性，以及EN对肠道屏障的保护作用。
将135例Child B或C级肝功能患者随机分为肠内营养组（EN组，65例）、全胃肠外营养组（TPN组，40例）和对照组（CON组，30例）。分别于术前1天、术后第5天和第10天测定营养参数、肝肾功能指标，比较不同营养支持的效果。采用脉冲电化学检测（高效液相色谱-脉冲电化学检测法，HPLC-PED）测定尿中乳果糖（L）和甘露醇（M）浓度，并计算L/M比值，以评估其对肠道屏障的保护效果。
EN组和TPN组术前术后肝肾功能均无明显损害。EN组术后最早达到正氮平衡，体重丢失最少，术后第1天（术前）L/M比值为0.026±0.004，术后第5天为0.030±0.004，术后第10天为0.027±0.005，术后无变化；而TPN组术后第5天变化显著（0.027±0.003 vs 0.038±0.009，P<0.01）。
EN是肝功能不全患者术后合理有效的营养支持方法，对肠道屏障有显著保护作用。
