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中华普通外科学文献(电子版) ›› 2015, Vol. 09 ›› Issue (06) : 446 -450. doi: 10.3877/cma.j.issn.1674-0793.2015.06.008

所属专题: 文献

论著

肝移植术后早期肠内营养降低终末期肝病患者移植术后感染发生率的研究
范明明1, 赵辉1, 傅斌生1, 安玉玲1, 易小猛1, 刘剑戎1, 易慧敏1,()   
  1. 1. 510080 广州,中山大学附属第三医院外科ICU
  • 收稿日期:2015-09-18 出版日期:2015-12-01
  • 通信作者: 易慧敏
  • 基金资助:
    广东省自然科学基金(S2013010016785); 广州市科技计划项目(2011Y1-00033-1)

Early enteral nutrition after liver transplantation reducing the incidence of postoperative infection in patients with end-stage liver disease

Mingming Fan1, Hui Zhao1, Binsheng Fu1, Yuling An1, Xiaomeng Yi1, Jianrong Liu1, Huimin Yi1,()   

  1. 1. Surgical Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2015-09-18 Published:2015-12-01
  • Corresponding author: Huimin Yi
  • About author:
    Corresponding author: Yi Huimin, Email:
引用本文:

范明明, 赵辉, 傅斌生, 安玉玲, 易小猛, 刘剑戎, 易慧敏. 肝移植术后早期肠内营养降低终末期肝病患者移植术后感染发生率的研究[J/OL]. 中华普通外科学文献(电子版), 2015, 09(06): 446-450.

Mingming Fan, Hui Zhao, Binsheng Fu, Yuling An, Xiaomeng Yi, Jianrong Liu, Huimin Yi. Early enteral nutrition after liver transplantation reducing the incidence of postoperative infection in patients with end-stage liver disease[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(06): 446-450.

目的

探讨肝移植术后早期肠内营养对患者感染发生率的影响。

方法

收集2012年6月至2015年1月于本中心行肝移植手术的全部病例,进行前瞻性队列研究。共有177例患者参与研究,其中60例在术后24 h内开展肠内营养,辅以肠外营养(试验组);117例早期予以全肠外营养,直至患者肛门排气后开始肠内营养(对照组)。根据患者术前的MELD评分进行分级,观察早期肠内营养对不同MELD评分的患者肝移植术后感染的影响。

结果

177例患者中共有106例(59.9%)发生术后感染。性别、MELD评分与早期肠内营养3个变量为影响总感染率的独立危险因素(P=0.027、0.045、0.000)。早期肠内营养可以降低11≤MELD评分≤20患者的术后感染发生率(P=0.014)。随着MELD评分增加,早期肠内营养对感染发生率的影响逐渐缩小。

结论

早期肠内营养可降低中度终末期肝病患者肝移植术后感染发生率。

Objective

To explore the influences of early enteral nutrition (EN) in the incidence of postoperative infection for patients after liver transplantation.

Methods

All the liver transplant patients between June 2012 and January 2015 in our center were collected in a prospective cohort study. This study enrolled 177 patients, including 60 patients in early enteral group who started initial enteral nutrition within 24 hours after surgery, and 117 patients who started with total parenteral nutrition (TPN) and did not start EN until anus exhaustion or defecation. Patients were classified according to the Model for End Stage Liver Disease (MELD) score. The effect of early enteral nutrition at different levels were analyzed to view whether the effect in patients with different levels was selective.

Results

One hundred and six cases (59.9%) were reported postoperative infection. Gender, MELD score and early enteral nutrition were independent risk factors affecting total infection rate (P=0.027, 0.045, 0.000). Early enteral nutrition reduced the infection rate in less severe patients, especially in patients whose MELD score was between 11-20 (P=0.014). With the increase of MELD score, the influence of early enteral nutrition on infection rates gradually narrowed.

Conclusion

Early enteral nutrition can significantly reduce the incidence of infection in patients with medium MELD score after transplantation.

表1 肝移植患者统计学基本资料
图1 试验组与对照组感染率
表2 患者总感染率影响因素的二元Logistic回归分析
图2 MELD评分5分级两组术后感染发生率趋势
表3 不同MELD分级早期肠内营养对总感染率的影响[例(%)]
1
Vieira PM, De-Souza DA, Oliveira LC. Nutritional assessment in hepatic cirrhosis; clinical, anthropometric, biochemical and hematological parameters[J]. Nutr Hosp, 2013, 28(5): 1615-1621.
2
García-Rodríguez MT, Pinón-Villar Mdel C, López-Calviño B, et al. Assessment of nutritional status and health-related quality of life before and after liver transplantation[J]. BMC Gastroenterol, 2015, 15(6): 1-9.
3
Dhaliwal R, Cahill N, Lemieux M, et al. The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies[J]. Nutr Clin Pract, 2014, 29(1): 29-43.
4
Merli M, Giusto M, Gentili F, et al. Nutritional status: its influence on the outcome of patients undergoing liver transplantation[J]. Liver Int, 2010, 30(2): 208-214.
5
Mtiller M J, Loyal S, Schwarze M, et al. Resting energy expenditure and nutritional state in patients with liver cirrhosis before and after liver transplantation[J]. Clin Nutr, 1994, 13(3): 145-152.
6
Wade JJ, Rolando N, Hayllar K, et al. Bacterial and fungal infections after liver transplantation: an analysis of 284 patients[J]. Hepatology, 1995, 21(5): 1328-1336.
7
Ikegami T, Shirabe K, Yoshiya S, et al. Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition[J]. J Am Coll Surg, 2012, 214(3): 288-295.
8
Hasse JM. Early Postoperative Tube Feeding in Liver Transplantation[J]. Nutr Clin Pract, 2014, 29(2): 222-228.
9
肖伟锴, 陈东, 李绍强, 等. 肝切除术后早期肠内肠外营养支持的系统评价[J/CD]. 中华普通外科学文献:电子版, 2013, 7(1): 61-69.
10
Langer G, Großmann K, Fleischer S, et al. Nutritional interventions for liver-transplanted patients[J]. Cochrane Database Syst Rev, 2012, 15(8): CD007605.
11
秦环龙, 尹明明. 肠道微生态和肠道营养[J/CD]. 中华普通外科学文献:电子版, 2015, 9(3): 182-187.
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