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目的比较Whipple术后经鼻空肠和空肠造口对肠内营养支持的影响。方法选取河北联合大学附属医院2008年1月至2013年5月期间实施的Whipple术患者87例,按不同的肠内营养方法分为经鼻空肠营养管组(47例)和空肠造口组(40例)。比较2组患者术后出现呕吐、腹胀、咽部疼痛等不良情况,术后出现坠积性肺炎情况及胰肠吻合口漏情况,住院时间,住院费用,术后第1、3、5 d血糖及血CL-、Na+、K+的浓度。结果空肠造口组患者呕吐、腹胀及咽部疼痛不良反应发生率和坠积性肺炎发生率均明显低于经鼻空肠营养管组(P<0.05),住院费用明显低于经鼻空肠营养管组(P<0.05)。2组胰肠吻合口漏发生率及住院时间比较差异均无统计学意义(P>0.05)。2组患者术后第1、3、5 d的血糖及血CL-、Na+、K+比较,差异亦均无统计学意义(P>0.05)。结论 Whipple术后经空肠造口行肠内营养,在减少术后出现呕吐、腹胀、咽部疼痛等不良情况和减少术后坠积性肺炎的发生方面与经鼻空肠行肠内营养比较有较好的临床效果,并在一定程度上减少住院费用,且住院时间、术后血糖及血电解质浓度无明显差异。
Objective To compare the effects of nasal jejunum and jejunostomy on the enteral nutrition support after Whipple surgery. Methods Eighty-seven Whipple patients from January 2008 to May 2013 in Affiliated Hospital of Hebei Union University were enrolled and divided into nasal jejunal feeding tube group (n = 47) and jejunal stoma group (n = 40 cases). Vomiting, abdominal distension and pharyngeal pain were compared between the two groups. Postoperative hypostatic pneumonia, pancreatic-anastomosis leakage, length of hospital stay, cost of hospitalization, blood glucose And blood CL-, Na +, K + concentration. Results The incidence of vomiting, abdominal distension and pharyngeal pain and the incidence of hypostatic pneumonia in jejunostomy group were significantly lower than those in nasal jejunal nutrition tube group (P <0.05), and the hospitalization cost was significantly lower than that in nasal jejunal nutrition tube Group (P <0.05). There was no significant difference between the two groups in the incidence of pancreaticojejunostomy leakage and hospital stay (P> 0.05). There was no significant difference in blood glucose, blood levels of CL-, Na + and K + between the two groups on the 1st, 3rd, 5th day after operation (P> 0.05). Conclusions After enteral nutrition by the jejunum of Whipple, there is a significant difference between the enteral nutrition of nasogastric jejunum and the enteral nutrition of reducing the incidence of postoperative vomiting, abdominal distension, pharyngeal pain and reducing postoperative hypostatic pneumonia Good clinical results, and to a certain extent, reduce the cost of hospitalization, and hospital stay, postoperative blood glucose and blood electrolyte concentration was no significant difference.