术前全肠外营养与肠内联合肠外营养对克罗恩病手术治疗效果影响的比较分析
Comparative analysis of preoperative total parenteral nutrition and enteral plus parenteral nutrition affecting the outcome of surgical treatment of Crohn's disease
孙振亚 1宋天润 2陈宇升 1郭振 1曹磊 1李毅 1朱维铭3
作者信息
- 1. 南京大学医学院附属金陵医院普通外科,江苏南京 210002
- 2. 南京医科大学附属金陵临床学院普通外科,江苏南京 210002
- 3. 南京中医药大学附属医院江苏省中医院炎症性肠病诊疗中心,江苏南京 210029
- 折叠
摘要
目的 评估术前采用全肠外营养(TPN)与肠内联合肠外营养(EN+PN)进行营养预康复对克罗恩病(CD)合并肠梗阻或肠瘘病人手术效果的影响.方法 回顾性分析2012-12-01-2021-12-01在南京大学医学院附属金陵医院普通外科炎症性肠病治疗中心因CD合并肠梗阻或肠瘘需要采用TPN或EN+PN进行营养预康复后行手术治疗的200例病人临床资料.根据采用营养预康复方式不同分为TPN组(137例)和EN+PN组(63例).采用倾向性评分匹配(PSM)方法比较TPN组与EN+PN组营养治疗效果与术后30d并发症的发生率.结果 PSM前,经营养预康复治疗后,TPN组和EN+PN组病人白蛋白水平和血红蛋白水平均较营养预康复治疗前升高,EN+PN 组的白蛋白水平高于 TPN 组[(35.7±4.4)g/L vs.(33.5±5.4)g/L,t=-2.79,P=0.003];EN+PN组C-反应蛋白低于TPN组,但差异无统计学意义[6.3(1.1,20.5)mg/Lvs.9.9(2.3,30.0)mg/L,Z=-1.27,P=0.201];EN+PN组血红蛋白水平高于TPN组(112.5±15.5 g/Lvs.105.3±18.8 g/L,t=-2.6,P=0.005).以血红蛋白和白蛋白为匹配变量,按1:2比例进行PSM后,TPN组和EN+PN组分别为96例和60例,两组预康复白蛋白水平和血红蛋白水平比较差异均无统计学意义(P均＞0.05).手术治疗后,TPN组较EN+PN组肠造口率(50.0％vs.30.0％,x2=6.1,P=0.022)、浅表切口 感染率(27.1％vs.10.0％,x2=6.6,P=0.018)、术后肠麻痹发生率(58.3％vs.33.3％,x2=9.2,P=0.004)和术后总体并发症发生率(70.8％vs.41.7％,x2=13.1,P=0.001)更高.此外,TPN组较EN+PN组的住院时间长[11.0(7.0,16.0)d vs.8.0(6.7,11.0)d,Z=-2.4,P=0.013].结论 TPN和EN+PN均可用于营养预康复,且均可取得满意的效果,但采用EN+PN进行营养预康复在营养治疗效果和手术结果方面可能更佳,值得进一步研究验证.
Abstract
Objective To assess the impact of preoperative nutritional prehabilitation with total parenteral nutrition(TPN)versus enteral combined parenteral nutrition(EN+PN)on the outcomes of surgical patients with Crohn's disease(CD)complicated with intestinal obstruction or intestinal fistula.Methods The clinical data of 200 patients who underwent surgery after nutritional prehabilitation with TPN or EN+PN for CD combined with intestinal obstruction or intestinal fistula at the Inflammatory Bowel Disease Treatment Centre of General Surgery Department,Affiliated Hospital of Medical School,Nanjing University,from 2012-12-01 to 2021-12-01 were retrospectively analyzed.The patients were divided into the TPN group(137 cases)and,the EN+PN group(63 cases)according to the different ways of nutritional prehabilitation used.The propensity score matching(PSM)method was used to compare the effects of nutritional treatment and the incidence of complications at 30 d postoperatively between the TPN group and the EN+PN group.Results Before PSM,patients in the TPN and EN+PN groups had higher albumin levels and hemoglobin levels after nutritional pre-rehabilitation therapy compared with those before nutritional pre-rehabilitation therapy,and the albumin level in the EN+PN group was higher than that in the TPN group(35.7±4.4 g/L vs.33.5±5.4 g/L,t=-2.79,P=0.003);C-reactive protein in the EN+PN group was lower than that in the TPN group,but the difference was not statistically significant,6.3(1.1,20.5)mg/Lvs.9.9(2.3,30.0)mg/L,Z=-1.27,P=0.201;hemoglobin levels were higher in the EN+PN group than in the TPN group,112.5+15.5 g/L vs.105.3±18.8 g/L,t=-2.6,P=0.005.After PSM with hemoglobin and albumin as matching variables in a 1:2 ratio,there were 96 cases in the TPN group and 60 cases in the EN+PN group,respectively,and there was no statistically significant difference in the comparison of the albumin level and hemoglobin level between the two groups(both P＞0.05).After surgical treatment,the incidence of enterostomy(50.0％vs.30.0％,x2=6.1,P=0.022),superficial wound infection(27.1％vs.10.0％,x2=6.6,P=0.018),ileus(58.3％vs.33.3％,x2=9.2,P=0.004),and overall postoperative complications(70.8％vs.41.7％,x2=13.1,P=0.001)were higher in the TPN group compared with the EN+PN group.In addition,the TPN group had a longer hospital stay than the EN+PN group,11.0(7.0,16.0)d vs.8.0(6.7,11.0)d,Z=-2.4,P=0.013.Conclusions Both TPN and EN+PN can be used for nutritional prehabilitation and both can achieve satisfactory results,but nutritional prehabilitation with EN+PN may be better in terms of nutritional treatment effects and surgical outcomes,which deserves further research to validate.
关键词
克罗恩病/全肠外营养/肠内营养/术后并发症/预康复Key words
Crohn's disease/total parenteral nutrition/enteral nutrition/postoperative complications,prehabilitation引用本文复制引用
基金项目
国家自然科学基金项目(82170573)
国家自然科学基金项目(81770556)
国家自然科学基金项目(82270543)
出版年
2024
国家科技期刊平台
NSTL
万方数据