Hasse J M, Blue L S, Liepa G U, Goldstein R M, Jennings L W, Mor E, Husberg B S, Levy M F, Gonwa T A, Klintmalm G B
Department of Surgery, Baylor University Medical Center, Dallas, Texas 75246, USA.
JPEN J Parenter Enteral Nutr. 1995 Nov-Dec;19(6):437-43. doi: 10.1177/0148607195019006437.
The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients.
Fifty transplant patients were randomized prospectively to receive enteral formula via nasointestinal feeding tubes (tube-feeding [TF] group) or maintenance i.v. fluid until oral diets were initiated (control group). Thirty-one patients completed the study. Resting energy expenditure, nitrogen balance, and grip strength were measured on days 2, 4, 7, and 12 after liver transplantation. Calorie and protein intakes were calculated for 12 days posttransplant.
Tube feeding was tolerated in the TF group (n = 14). The TF patients had greater cumulative 12-day nutrient intakes (22,464 +/- 3554 kcal, 927 +/- 122 g protein) than did the control patients (15,474 +/- 5265 kcal, 637 +/- 248 g protein) (p < .002). Nitrogen balance was better in the TF group on posttransplant day 4 than in the control group (p < .03). There was a rise in the overall mean resting energy expenditure in the first two posttransplant weeks from 1487 +/- 338 to 1990 +/- 367 kcal (p = .0002). Viral infections occurred in 17.7% of control patients compared with 0% of TF patients (p = .05). Although other infections tended to occur more frequently in the control group vs the TF group (bacterial, 29.4% vs 14.3%; overall infections, 47.1% vs 21.4%), these differences were not statistically significant. Early posttransplant tube feeding did not influence hospitalization costs, hours on the ventilator, lengths of stay in the intensive care unit and hospital, rehospitalizations, or rejection during the first 21 posttransplant days.
Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients.
本研究旨在确定术后早期管饲对肝移植受者预后的影响。
50例移植患者被前瞻性随机分组，通过鼻肠饲管接受肠内营养配方（管饲[TF]组）或维持静脉输液直至开始经口饮食（对照组）。31例患者完成了研究。在肝移植术后第2、4、7和12天测量静息能量消耗、氮平衡和握力。计算移植后12天的热量和蛋白质摄入量。
TF组（n = 14）对管饲耐受。TF组患者12天累计营养摄入量（22464±3554千卡，927±122克蛋白质）高于对照组患者（15474±5265千卡，637±248克蛋白质）（p <.002）。移植后第4天TF组的氮平衡优于对照组（p <.03）。移植后前两周总体平均静息能量消耗从1487±338千卡增加到1990±367千卡（p =.0002）。对照组17.7%的患者发生病毒感染，而TF组患者为0%（p =.05）。虽然与TF组相比，对照组其他感染的发生率往往更高（细菌感染，29.4%对14.3%；总体感染，47.1%对21.4%），但这些差异无统计学意义。移植后早期管饲不影响住院费用、呼吸机使用时间、重症监护病房和医院住院时间、再次住院或移植后前21天内的排斥反应。
移植后早期管饲可耐受，并能改善某些预后，所有肝移植患者均应考虑采用。
