胰十二指肠切除术后家庭肠内营养的效果。

Effect of home enteral nutrition after pancreaticoduodenectomy.

机构信息

Hepato-Pancreatico-Biliary Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Department of Clinical Nutrition Therapy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.

出版信息

Nutrition. 2019 Apr;60:206-211. doi: 10.1016/j.nut.2018.10.007. Epub 2018 Oct 10.

DOI:10.1016/j.nut.2018.10.007

PMID:30616102

Abstract

OBJECTIVES

Providing home enteral nutrition (HEN) might prevent further deterioration of nutritional status and reduce complication risk after very invasive abdominal surgery. The aim of this study was to assess the effect of HEN after pancreaticoduodenectomy (PD).

METHODS

Between January 2013 and July 2016, 150 consecutive patients underwent PD. All patients received postoperative enteral nutrition until discharge. HEN (400 or 800 kcal/d) was introduced in March 2015 for patients with reduced food intake (daily, <15 kcal/kg ideal body weight) at discharge (HEN group). Patients with low intake at discharge treated before March 2015 were considered historical controls (non-HEN group). All patients received postoperative enteral nutrition until discharge. Primary outcomes measures included morbidity rate and nutritional status including body weight and blood examination from discharge until postoperative day (POD) 90.

RESULTS

The HEN and non-HEN groups included 24 and 39 patients, respectively. HEN was provided for a median of 68 d (range, 21-90 d) and two patients (8.4%) developed tube obstruction during HEN. The HEN group showed significantly lower rate of morbidity of Clavien-Dindo grade II from discharge to POD 90 or higher (4 of 24, 16.7% versus 17 of 39, 46.1%; P = 0.031) and significantly higher rate of increase in body weight (median: 4.9% versus -4%; P = 0.003), serum albumin levels on POD 90 (median: 3.8 versus 3.5 g/dL; P = 0.020), and prognostic nutritional index (median: 48.5 versus 42.5; P = 0.012). Multivariate logistic analysis demonstrated that body weight at discharge (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.53-0.97) and not receiving HEN (OR, 3.86; 95% CI, 1.81-15.2) were prognostic factors for morbidity after discharge.

CONCLUSION

HEN is safe and may reduce postdischarge morbidity and improve nutritional status after PD.

摘要

目的

提供家庭肠内营养（HEN）可能会防止在接受非常侵袭性的腹部手术后营养状况进一步恶化，并降低并发症风险。本研究旨在评估 HEN 对胰十二指肠切除术（PD）后的影响。

方法

2013 年 1 月至 2016 年 7 月，150 例连续患者接受 PD。所有患者均接受术后肠内营养直至出院。2015 年 3 月起，对出院时（HEN 组）进食量减少（每天<15 千卡/公斤理想体重）的患者开始提供 HEN（400 或 800 千卡/天）。2015 年 3 月前接受治疗的低摄入量患者被视为历史对照（非 HEN 组）。所有患者均接受术后肠内营养直至出院。主要观察指标包括发病率和营养状况，包括出院至术后第 90 天（POD90）的体重和血液检查。

结果

HEN 组和非 HEN 组分别有 24 例和 39 例患者。HEN 的中位使用时间为 68 天（范围，21-90 天），2 例患者（8.4%）在 HEN 期间发生管腔阻塞。HEN 组出院至 POD90 时的 Clavien-Dindo 分级 II 及以上发病率显著较低（4 例[16.7%]与 17 例[46.1%]；P=0.031），体重增加率显著较高（中位数：4.9%与-4%；P=0.003），POD90 时血清白蛋白水平（中位数：3.8 与 3.5 g/dL；P=0.020）和预后营养指数（中位数：48.5 与 42.5；P=0.012）。多变量逻辑分析表明，出院时体重（比值比[OR]，0.63；95%置信区间[CI]，0.53-0.97）和未接受 HEN（OR，3.86；95%CI，1.81-15.2）是出院后发病率的预后因素。