EARLY ENTERAL NUTRITION SUPPORT IN PATIENTS UNDERGOING LIVER-TRANSPLANTATION
EARLY ENTERAL NUTRITION SUPPORT IN PATIENTS UNDERGOING LIVER-TRANSPLANTATION
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DOI：
10.1177/0148607195019006437
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发表时间：
1995-11-01
影响因子：
3.4
通讯作者：
KLINTMALM, GB
中科院分区：
文献类型：
--
作者：
HASSE, JM;BLUE, LS;KLINTMALM, GB
背景：本研究的目的是确定术后早期管饲对肝移植受者结局的影响。方法：50 名移植患者前瞻性地随机接受通过鼻肠饲管的肠内配方奶粉（管饲[TF]组）或维持性 TV 液体，直到开始口服饮食（对照组）。三十一名患者完成了这项研究。肝移植后第 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 天的卡路里和蛋白质摄入量。结果：TF 组可以耐受管饲 (n = 14)。 TF 患者的 12 天累积营养摄入量（22,464 +/- 3554 kcal，927 +/- 122 g 蛋白质）高于对照患者（15,474 +/- 5265 kcal，637 +/- 248 g 蛋白质）（P < .002）。移植后第 4 天，TF 组的氮平衡优于对照组 (P < .03)。移植后前两周的总体平均静息能量消耗从 1487 +/- 338 kcal 上升至 1990 +/- 367 kcal (P = .0002)。对照患者的病毒感染率为 11.7%，而 TF 患者的病毒感染率为 0% (P = .05)。尽管其他感染在对照组中比 TF 组中发生的频率更高（细菌感染，分别为 29.4% 和 14.3%；总体感染，分别为 47.1% 和 21.4%），但这些差异并不具有统计学意义。移植后早期管饲不会影响移植后前 21 天内的住院费用、呼吸机使用时间、在重症监护室和医院的住院时间、再住院或排斥反应。结论：移植后早期管饲是可以耐受的，并且可以促进某些结果的改善，所有肝移植患者都应该考虑。
Background: The purpose of this study was to determine the effects of early postoperative tube feeding on outcomes of liver transplant recipients. Methods: Fifty transplant patients were randomized prospectively to receive enteral formula via nasointestinal feeding tubes (tube-feeding [TF] group) or maintenance TV 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. Results: 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 11.7% of control patients compared with 0% of TF patients (P = .05). Although other infections tended to occur more frequently in the control group us the TF group (bacterial, 29.4% us 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. Conclusions: Early posttransplant tube feeding was tolerated and promoted improvements in some outcomes and should be considered for all liver transplant patients.