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目的 术后早期肠内营养支持对胃肠恶性肿瘤病人肠粘膜通透性的影响。方法 2 0例经病理证实为胃肠恶性肿瘤的病人随机分为 2组 ,肠外营养 (PN)组和肠内营养 (EN)组。PN组术后行TPN支持 ,能量为 10 5kJ/kg·d ,氮入量 0 .2 g/kg·d。EN组术后第 1天起经鼻饲管输注能全力 ,量由 5 0 0ml/d递增至 15 0 0ml/d速度由 2 1ml/h递增至 6 3ml/h。分别于术前 1d及术后第8天分别给病人口服甘露醇 5g和乳果糖 10 g ,收集病人随后 6h的全部尿液 ,测量其甘露醇排除率与乳果糖排除率之比值 (Lactulose/mannitolratio ,L/M比值 )。结果 2 0例胃肠恶性肿瘤患者术前L/M值为 (0 .0 47± 0 .0 2 5 ) ,与正常人群相比差异有极显著性 (P <0 .0 1)。术前PN组的L/M比值为 (0 .0 5 0± 0 .0 30 ) ,EN组为 (0 .0 44± 0 .0 2 3) ,两组间差异无显著性 (P >0 .0 5 )。术后第 8天 ,PN组L/M比值 (0 .10 6± 0 .0 34) ,EN组的L/M比值为 (0 .0 84± 0 .40 ) ,两组分别与术前相比差异有极显著性 (P <0 .0 1) ,两组间相比差异无显著性 (P >0 .0 5 )。结论 术后早期短程应用能全力肠内营养支持对于胃肠恶性肿瘤病人的肠粘膜通透性的影响与肠外营养支持相比差异无显著性
Objective To investigate the effect of early postoperative enteral nutrition on intestinal mucosal permeability in patients with gastrointestinal malignant tumors. Methods Twenty patients with pathologically confirmed gastrointestinal malignant tumors were randomly divided into two groups: PN group and EN group. The PN group received TPN after operation with an energy of 10 5 kJ / kg · d and a nitrogen dose of 0.2 g / kg · d. EN group from the first day postoperative nasal feeding tube can be full, the amount of 500ml / d increased to 15 0ml / d speed from 21ml / h to 6 3ml / h. The patients were given oral mannitol 5g and lactulose 10g respectively on the first day and the eighth day after operation, and all the urine of the patients were collected 6h later. The ratio of mannitol to lactulose was measured (Lactulose / mannitolratio , L / M ratio). Results The preoperative L / M value of 20 patients with gastrointestinal malignancy was (0.47 ± 0.255), which was significantly different from that of the normal population (P <0.01). The L / M ratio of preoperative PN group was (0.050 ± 0.030) and that of EN group was (0.44 ± 0.22), there was no significant difference between the two groups (P> 0 .0 5). On the 8th postoperative day, the L / M ratio (0. 106 ± 0. 0 34) in PN group and the L / M ratio in EN group were (0.84 ± 0.40) The difference was significant (P <0.01). There was no significant difference between the two groups (P> 0.05). Conclusions The effect of early postoperative short-range application of full-strength enteral nutrition support on intestinal mucosal permeability in patients with gastrointestinal malignancies was not significantly different from that of parenteral nutrition support