早期肠内营养支持在门脉高压行TIPS术后患者中的应用价值

doi:10.3760/cma.j.issn.1007-1245.2022.16.007

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (16): 2250-2254.DOI: 10.3760/cma.j.issn.1007-1245.2022.16.007

早期肠内营养支持在门脉高压行TIPS术后患者中的应用价值

张盼盼¹ 王朝阳² 鹿璐³ 燕彦⁴

¹河南科技大学第一附属医院河南科技大学护理学院肿瘤内科，洛阳　471000； ²河南科技大学第一附属医院河南科技大学护理学院介入科，洛阳　471000； ³河南科技大学第一附属医院河南科技大学护理学院消化内科，洛阳　471000； ⁴河南科技大学第一附属医院河南科技大学护理学院肝胆外科，洛阳　471000

收稿日期:2022-03-30 出版日期:2022-08-15 发布日期:2022-08-15
通讯作者: 张盼盼，Email：zfwisnpp@163.com
基金资助:
河南省医学科技攻关计划（联合共建）项目（LHGJ20190562）

Value of early enteral nutritional support in patients undergoing TIPS for portal hypertension

Zhang Panpan¹, Wang Chaoyang², Lu Lu³, Yan Yan⁴

¹Department of Oncology, School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China; ²Department of Interventional Surgery, School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China; ³Department of Gastroenterology, School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China; ⁴Department of Hepatobiliary Surgery, School of Nursing, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China

Received:2022-03-30 Online:2022-08-15 Published:2022-08-15
Contact: Zhang Panpan, Email: zfwisnpp@163.com
Supported by:
Henan Medical Science and Technology Project (Joint Construction) (LHGJ20190562)

摘要/Abstract

摘要： 目的　研究早期肠内营养支持方案对门脉高压行经颈静脉肝内门-体分流术（TIPS）后患者应激反应水平、肝功能及营养状态的影响。方法　进行前瞻性研究，选取2018年7月至2020年10月期间河南科技大学第一附属医院95例肝硬化门脉高压症TIPS术后患者作为研究对象，采用随机数字表法分为对照组47例和观察组48例。对照组男32例、女15例，年龄（48.32±4.25）岁，给予常规营养支持；观察组男32例、女16例，年龄（49.61±4.41）岁，给予早期肠内营养支持方案。对比两组患者肝功能、应激反应水平、营养状态。计数资料采用χ²检验，计量资料采用t检验。结果　观察组干预后血清白蛋白（Alb）水平为（39.68±4.23）U/L，高于对照组（35.89±4.50）U/L，总胆红素（TBil）水平为（14.22±2.63）μmol/L，低于对照组（18.54±2.15）μmol/L，差异均有统计学意义（均P<0.05）。观察组干预后转铁蛋白（TRF）水平、前白蛋白（PA）水平、预后营养指数（PNI）分别为（2.78±0.30）g/L、（3.33±0.42）g/dl、（58.24±3.34），均高于对照组（2.53±0.38）g/L、（2.98±0.40）g/dl、（55.62±3.85），差异均有统计学意义（均P<0.05）。观察组干预后C反应蛋白（CRP）、凝血酶原时间（PT）水平分别为（14.08±3.62）mg/L、（13.42±0.62）s，均低于对照组（20.35±4.25）mg/L、（15.75±0.80）s，差异均有统计学意义（均P<0.05）。结论　早期肠内营养支持方案对肝硬化门脉高压症TIPS术后患者效果确切，能够有效改善患者营养状态和肝功能，降低应激反应水平，具有临床推广价值。

关键词: 肝功能, 早期肠内营养支持, 肝硬化门脉高压症, 经颈静脉肝内门-体分流术

Abstract: Objective　To investigate the effects of early enteral nutrition support program on stress response level, liver function, and nutritional status in patients undergoing transjugular intrahepatic portal-body shunt (TIPS) for portal hypertension. Methods　A prospective study was conducted on 95 cirrhotic portal hypertension patients after TIPS surgery in The First Affiliated Hospital of Henan University of Science and Technology from July 2018 to October 2020. The patients were divided into two groups by the random number table method. The control group consisted of 47 patients, 32 males and 15 females, aged (48.32±4.25) years; the observation group consisted of 48 patients, 32 males and 16 females, aged (49.61±4.41) years. The control group received routine nutritional support, and the observation group received early enteral nutrition support program. The liver function, stress response level, and nutritional status were compared between the two groups. χ² test was used for the count data and t test was used for the measurement data. Results　After intervention, the serum albumin (Alb) level in the observation group was (39.68±4.23) U/L, which was higher than that in the control group [(35.89±4.50) U/L], and the total bilirubin (TBil) level was (14.22±2.63) μmol/L, which was lower than that in the control group [(18.54±2.15) μmol/L], with statistically significant differences (both P<0.05). After intervention, the levels of transferrin (TRF) and prealbumin (PA) and prognostic nutrition index (PNI) in the observation group were (2.78±0.30) g/L, (3.33±0.42) g/dl, and (58.24±3.34), which were higher than those in the control group [(2.53±0.38) g/L, (2.98±0.40) g/dl, and (55.62±3.85)], with statistically significant differences (all P<0.05). After intervention, the levels of C-reactive protein (CRP) and prothrombin time (PT) in the observation group were (14.08±3.62) mg/L and (13.42±0.62) s, which were lower than those in the control group [(20.35±4.25) mg/L and (15.75±0.80) s], with statistically significant differences (both P<0.05). Conclusions　Early enteral nutrition support program has a definite effect on patients with cirrhotic portal hypertension after TIPS, which can effectively improve their nutritional status and liver function and reduce their stress response level, with clinical promotion value.

Key words: Liver function, Early enteral nutritional support, Cirrhotic portal hypertension, Transjugular intrahepatic portal-body shunt

张盼盼　王朝阳　鹿璐　燕彦. 早期肠内营养支持在门脉高压行TIPS术后患者中的应用价值[J]. 国际医药卫生导报, 2022, 28(16): 2250-2254.

Zhang Panpan, Wang Chaoyang, Lu Lu, Yan Yan. Value of early enteral nutritional support in patients undergoing TIPS for portal hypertension[J]. International Medicine and Health Guidance News, 2022, 28(16): 2250-2254.

参考文献

[1] 李赵鹏,王广川,张春清. 经颈静脉肝内门体分流术对脾切除术后门静脉血栓患者食管静脉曲张再出血的预防价值[J]. 临床肝胆病杂志,2021,37(6):1331-1335. DOI:10.3969/j.issn.1001-5256.2021.06.023.
[2] 徐寅,王玲,王忠敏,等. TIPS术后集束化延续性护理管理方案的构建[J]. 介入放射学杂志,2021,30(8):832-836. DOI:10.3969/j.issn.1008-794X.2021.08.018.
[3] Yao MJ, Wang LJ, Liu S, et al. Application of serum Golgi protein-73 in the management of chronic liver disease[J].Chin Med J (Engl),2020,134(7):777-779. DOI:10.1097/CM9.0000000000001296.
[4] Li M, Wang ZQ, Zhang L, et al. Burden of cirrhosis and other chronic liver diseases caused by specific etiologies in China, 1990-2016: findings from the Global Burden of Disease Study 2016[J].Biomed Environ Sci,2020,33(1):1-10. DOI:10.3967/bes2020.001.
[5] 杜以霞,张晖. 早期肠外及肠内阶段性微生态免疫营养支持与单纯肠内营养对急性重症胰腺炎的改善效果分析[J]. 国际医药卫生导报,2021,27(1):89-92. DOI:10.3760/cma.j.issn.1007-1245.2021.01.023.
[6] 汪效松,陈兴泳,张旭,等. 早期肠内营养支持对老年急性脑梗死患者临床结局的影响[J]. 中国老年学杂志,2017,37(8):1928-1930. DOI:10.3969/j.issn.1005-9202.2017.08.046.
[7] 宫雪梅,叶向红,薛阳阳,等. 重症患者早期肠内营养耐受性评估及管理方案的构建[J]. 中华护理杂志,2019,54(4):490-494. DOI:10.3761/j.issn.0254-1769.2019.04.002.
[8] 中国门静脉高压诊断与监测研究组(CHESS),中华医学会消化病学分会微创介入协作组,中国医师协会介入医师分会急诊介入专委会,等. 中国肝静脉压力梯度临床应用专家共识(2018版)[J]. 中华肝脏病杂志,2018,26(11):801-812. DOI:10.3760/cma.j.issn.1007-3418.2018.11.001.
[9] Warnes TW, Roberts SA, Smith A, et al. Portal hypertension in primary biliary cholangitis: prevalence, natural history and histological correlates[J].Eur J Gastroenterol Hepatol,2021,33(12):1595-1602. DOI:10.1097/MEG.0000000000002033.
[10] 贾晨雨,郭丹,林震宇,等. 甲状腺功能亢进性肝损害与甲巯咪唑继发性肝损害的临床比较研究[J]. 临床内科杂志,2020,37(1):23-26. DOI:10.3969/j.issn.1001-9057.2020. 01.007.
[11] 朱廷芳,马秀莲,杜雯雯,等. 基于营养风险筛查的营养干预在失代偿期肝硬化患者中的应用[J]. 护理实践与研究,2020,17(3):65-68. DOI:10.3969/j.issn.1672-9676.2020. 03.022.
[12] 朱丽红,梁美华.集束化护理对经颈静脉肝内门体分流术术后分流道失效所致上消化道再出血的防治效果[J].血栓与止血学,2022,28(6):1065-1066. DOI:10.3969/j.issn.1009- 6213.2022.06.071.
[13] 潘红,蔡英华,许正红,等. 营养支持联合早期运动对肺移植术后患者康复的影响[J]. 护理学杂志,2019,34(9):42-44. DOI:10.3870/j.issn.1001-4152.2019.09.042.
[14] 刘宇,毛正发,杜波,等. 营养支持治疗对肝癌患者术后恢复及远期生存的影响[J]. 肝胆胰外科杂志,2018,30(6):457-461. DOI:10.11952/j.issn.1007-1954.2018.06.004.
[15] 梁艳,李艳娟. 低出生体重先天性心脏病患儿术后肠内营养支持的集束化护理研究[J]. 护理研究,2019,33(5):871-874. DOI:10.12102/j.issn.1009-6493.2019.05.033.
[16] 裴文晔,于玲,姜桂春. 食管癌术后早期肠内营养支持的临床效果[J]. 中国医科大学学报,2021,50(6):544-547. DOI:10.12007/j.issn.0258-4646.2021.06.014.
[17] 李盼. 早期肠内营养支持对重症胰腺炎患者营养状况及免疫功能的影响[J]. 江西医药,2021,56(9):1505-1507. DOI:10.3969/j.issn.1006-2238.2021.09.061.
[18] 邓凯元,单廷,顾琛,等. 益生菌联合早期肠内营养支持对于胃癌病人术后康复的影响[J]. 肠外与肠内营养,2021,28(4):207-210,215. DOI:10.16151/j.1007-810x.2021.04.004.
[19] 齐彤,王文. 早期肠内营养支持治疗对老年股骨颈骨折患者术后恢复的影响[J]. 临床医学,2021,41(5):87-89. DOI:10.19528/j.issn.1003-3548.2021.05.035.
[20] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志,2019,18(12):1087-1093. DOI:10.3760/cma.j.issn.1673-9752.2019. 12.001.
[21] 王杰,黎钢.脾切除后经脾静脉冠肾静脉分流术治疗门静脉高压症的临床疗效[J].血栓与止血学,2022,28(3):1012-1014. DOI:10.3969/j.issn.1009-6213.2022.06.046.
[22] 赵剑波,谭卿. 非肝硬化性门静脉高压症研究进展[J]. 实用肝脏病杂志,2021,24(5):613-616. DOI:10.3969/j.issn.1672-5069.2021.05.002.
[23] 邵幼林,范建高. 非酒精性脂肪性肝病的流行现状与危害[J]. 中华肝脏病杂志,2019,27(1):10-13. DOI:10.3760/cma.j.issn.1007-3418.2019.01.004.
[24] 赵辉. 不同营养支持方式对慢性阻塞性肺疾病急性加重并呼吸衰竭患者营养状态、肺功能及炎性因子影响的对比研究[J]. 实用心脑肺血管病杂志,2019,27(4):77-82. DOI:10.3969/j.issn.1008-5971.2019.04.y02.
[25] 北京医学会肠外肠内营养学会专业委员会,«慢性肝病患者肠外肠内营养支持与膳食干预专家共识». 慢性肝病患者肠外肠内营养支持与膳食干预专家共识[J]. 中华肝胆外科杂志,2017,23(2):73-81. DOI:10.3760/cma.j.issn.1007- 8118.2017.02.001.
[26] 中华医学会肝病学分会,中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志,2019,35(6):1222-1230. DOI:10.3969/j.issn.1001-5256.2019.06.010.
[27] 白求恩公益基金会创伤骨科专业委员会,中国医疗保健国际交流促进会加速康复外科学分会创伤骨科学组. 加速康复外科理念下桡骨远端骨折诊疗方案优化的专家共识[J]. 中华创伤骨科杂志,2019,21(2):93-101. DOI:10.3760/cma.j.issn.1671-7600.2019.02.001.
[28] 徐惠圆,李昌平. 益肠内营养联合益生菌对非酒精性肝病肝纤维化的治疗效果及临床应用价值[J]. 现代消化及介入诊疗,2021,26(2):187-191,196. DOI:10.3969/j.issn.1672- 2159.2021.02.009.
[29] 彭启旺,邓浩. 肠内营养支持对根治性胃癌术后胃肠功能、营养状态和应激炎性反应影响[J]. 临床外科杂志,2021,29(5):445-448. DOI:10.3969/j.issn.1005-6483.2021. 05.014.
[30] 杨永强,陈稳,张国栓,等. 不同营养支持对结肠癌腹腔镜全结肠系膜切除术患者营养状况、免疫功能及应激反应的影响[J]. 河北医药,2021,43(4):531-535. DOI:10.3969/j.issn.1002-7386.2021.04.011.
[31] 傅宇,徐群. 肠内营养支持对胃癌患者术后营养、肠道菌群及应激反应的影响[J]. 中国现代普通外科进展,2020,23(6):488-490. DOI:10.3969/j.issn.1009-9905.2020.06.022.

早期肠内营养支持在门脉高压行TIPS术后患者中的应用价值

Value of early enteral nutritional support in patients undergoing TIPS for portal hypertension

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

编辑推荐

Metrics