保留结肠对接受家庭肠外营养患者肠外能量需求的意义。

Significance of a preserved colon for parenteral energy requirements in patients receiving home parenteral nutrition.

作者信息

Jeppesen P B, Mortensen P B

机构信息

Dept. of Medicine, Rigshospitalet, University of Copenhagen, Denmark.

出版信息

Scand J Gastroenterol. 1998 Nov;33(11):1175-9. doi: 10.1080/00365529850172539.

DOI:10.1080/00365529850172539

PMID:9867096

Abstract

BACKGROUND

Colonic digestion has been reported to salvage up to 3-4 MJ/day in short-bowel patients (approximately 50% of the daily requirements).

METHODS

A cross-sectional study of the parenteral support given to a total cohort of 73 patients receiving home parenteral nutrition (HPN) in Denmark on 31 December 1995 was performed to evaluate the significance of a preserved colon for the prevalence of short-bowel patients in need of HPN and the requirements of energy given as HPN. The number of HPN patients with a substantial remnant colon (> or =50%) was compared with the number with no colonic function (0%) in subgroups of patients with remnant small bowels of <100 cm (group 1), 100-200 cm (group 2), and >200 cm (group 3). Patients with pseudo-obstruction (n = 8) and patients with <50% colon remaining (n = 11) were excluded from the analysis. The impact of a substantial preserved colonic function (> or =50%) on the parenteral energy requirements was evaluated in patients with comparable lengths of small bowel.

RESULTS

Twelve and 8 patients in group 1 had no colon and > or =50% colon in function, respectively, in contrast to patients in group 2, in which 21 had no colon in function and only 2 had >50% in function (Fisher's exact test, P = 0.028). In patients in group 1 the need for parenteral energy in percentage of basal energy expenditure (HPN/BEE%, mean +/- standard deviation) was 110 +/- 31% in patients with no colon and 59 +/- 31% in patients with a preserved colon (P = 0.001). In patients without a colon in groups 2 and 3 the HPN/BEE% was 58 +/- 45% and 33 +/- 47%, respectively.

CONCLUSIONS

Preservation of a substantial colonic function (> or =50%) is rare in patients in need of HPN with >100 cm remnant small bowel and results in a reduction in the parenteral energy requirements of approximately 3 MJ/day (51% of BEE) in patients with <100 cm small bowel. These data reinforce the reports of the colon as an energy-salvaging organ (approximately 3-4 MJ/day), which makes HPN unnecessary in most patients in whom small-bowel length is sufficient (>100 cm) to absorb another 3-4 MJ/day.

摘要

背景

据报道，结肠消化可使短肠患者每天节省3 - 4兆焦耳能量（约占每日需求量的50%）。

方法

对1995年12月31日丹麦73例接受家庭肠外营养（HPN）的患者进行了一项关于肠外支持的横断面研究，以评估保留结肠对于需要HPN的短肠患者患病率以及HPN能量需求的意义。将残留结肠较多（≥50%）的HPN患者数量与残留小肠长度<100厘米（第1组）、100 - 200厘米（第2组）和>200厘米（第3组）亚组中无结肠功能（0%）的患者数量进行比较。分析排除了假性肠梗阻患者（n = 8）和结肠残留<50%的患者（n = 11）。在小肠长度相当的患者中评估保留大量结肠功能（≥50%）对肠外能量需求的影响。

结果

第1组分别有12例和8例患者无结肠功能和结肠功能≥50%，而第2组中，21例无结肠功能，仅2例结肠功能>50%（Fisher精确检验，P = 0.028）。在第1组患者中，无结肠功能患者的肠外能量需求占基础能量消耗的百分比（HPN/BEE%，平均值±标准差）为110±3%，有保留结肠功能的患者为59±31%（P = 0.001）。第2组和第3组中无结肠功能的患者HPN/BEE%分别为58±45%和33±47%。

结论

在残留小肠>100厘米且需要HPN的患者中，保留大量结肠功能（≥50%）的情况很少见，并且在小肠长度<100厘米的患者中可使肠外能量需求减少约3兆焦耳/天（占基础能量消耗的51%）。这些数据进一步证实了结肠作为一个能量节省器官（约3 - 4兆焦耳/天）的报道，这使得在大多数小肠长度足以吸收额外3 - 4兆焦耳/天的患者中无需进行HPN。