【摘要】 目的 评价肠内营养对喉切除术后患者蛋白代谢、内毒素血症和预后的影响。方法 采用前瞻、随机和对照的方法，29例接受喉切除手术患者分为肠内营养组(EN组，14例)和肠外营养组(PN组，15例)，两组患者具有可比性，术后分别给予整蛋白型肠内营养和等氮、等热卡的肠外营养均12天，对血浆谷氨酰胺浓度、血浆蛋白和内毒素水平以及死亡率、感染并发症、术后住院日和住院费用等预后指标进行观察。结果 两组患者术后2～12天接受不同的营养支持，EN组术后12天血浆的谷氨酰胺水平为(611±61)μmol/L，明显高于PN组的(442±97)μmol/L(P<0.05)；术后各蛋白指标均有不同程度下降，EN组和PN组的结果相似；术后1天的内毒素水平较术前明显升高，随时间可逐渐下降，但EN组的下降幅度在术后4、8和12天要快于PN组；死亡率两组均为0；感染并发症EN组1例，少于PN组3例；术后住院日两组结果相似；营养药费EN组仅为PN组36.6%，总住院费用相似。结论 肠内营养能减轻内毒素血症，改善营养代谢，更为经济和可能减少感染并发症。

    【关键词】 肠内营养；喉切除；内毒素血症；感染并发症；随机对照研究

    Effects of enteral nutrition on plasma protein metabolism,endotoxemia,and the outcome of the post-laryngectomy patients

    WANG Xiao-yun,WU Yue-huang.

    Department of Otorhinolaryngology,Beijing Hospital,Beijing 100730,China

    【Abstract】 Objective To evaluate the effects of enteral nutrition on plasma protein metabolism,endotoxemia,and the outcome of the post-laryngectomy patients.Methods A prospective,randomized and controlled clinical trial was designed for this study.29 post-laryngectomy patients were randomly divided into two groups:the enteral nutrition group (EN group,14 cases) and the parenteral nutrition group (PN group,15 cases).The patients enrolled in the two groups were comparable and received isonitrogenous and isocaloric nutritional support for 12 days after operation.The plasma glutamine,protein and endotoxin level were measured.The mortality and the infectious complications rate were monitored.And the length of stay and costs of hospitalization were recorded.Results Two groups were received different nutritional support from post-operation day 2 to day 12.The plasma glutamine level was (611±61)μmol/L in EN group on post-operation day 12,which is significantly higher than PN group(442±97)μmol/L.The plasma protein concentration has no difference between the two groups.The plasma endotoxin level was increased manifestly on post-operation day 1 comparing with the pre-operation days.It then decreased gradually.On post-operation day 4,8 and 12,it was lower in EN group than PN group,but no significant difference was detected (P>0.05).In this study,no patient was dead.1 infectious complication case was reported in EN group,while 3 of them in PN group.No difference was observed in post-operation stay and hospitalization cost.Conclusion Enteral nutrition is a cost efficient way in reducing the incidence rate of endotoxemia,improving the nutrition metabolism,and preventing infectious complications. ......