经皮肝穿胆道支架置入减黄术前鱼油脂肪乳的应用方法与效果分析(1)
[摘要] 目的 探讨经皮肝穿胆道支架置入减黄术前鱼油脂肪乳的应用方法与效果。 方法 选择2013年9月～2016年2月选择在空军总医院诊治的恶性梗阻性黄疸患者156例，随机数字表法分为观察组与对照组，每组各78例。所有患者均行经皮肝穿胆道支架置入减黄手术治疗，观察组给予口服鱼油脂肪乳辅助治疗，对照组给予静脉输注鱼油脂肪乳辅助治疗，从术前5 d开始口服、输注营养液至手术日，观察两组术后情况。 结果 观察组累计正氮平衡明显多于对照组(P < 0.05)。观察组术后1、12 d的血清白介素-6(IL-6)与肿瘤坏死因子-α(TNF-α)水平明显低于对照组(P < 0.05)，且术后12 d的血清IL-6与TNF-α水平明显低于术后1 d(P < 0.05)。两组术后均无死亡病例，观察组术后并发症发生率与术后住院时间都明显少于对照组(P < 0.05)。 结论 恶性梗阻性黄疸减黄术前采用口服鱼油脂肪乳支持治疗能有效改善患者的肝功能与炎症表达状况，有助于促进患者恢复、减少并发症的发生，有很好的应用价值。
[关键词] 恶性梗阻性黄疸；减黄手术；肝功能；鱼油脂肪乳
[中图分类号] R730.5 [文献标识码] A [文章编号] 1673-7210(2017)02(b)-0110-04
[Abstract] Objective To investigate the application method and effect of fish oil fat emulsion before percutaneous transhepatic biliary stent placement. Methods From September 2013 to February 2016， in Air Force General Hospital of PLA， 156 patients with malignant obstructive jaundice were selected， according to radomnumber table， they were divided into observation group and control group， with 78 cases in each group. All patients were given percutaneous transhepatic biliary stent placement operation， the observation group were given oral fish oil fat emulsion support treatment， the patients in the control group were given intravenous infusion of fish oil fat emulsion support treatment， the support treatment was from 5 d before the operation to the day of surgery， the presentation of the two groups after operation were observed. Results The cumulative nitrogen balance in the observation group was significantly more than that in the control group (P < 0.05). The serum IL-6 and TNF-α in the observation group at postoperative 1， 12 d were significantly lower than those in the control group (P < 0.05)， and the serum IL-6 and TNF-α at postoperative 12 d were were significantly lower than those at the postoperative 1 d (P < 0.05). There was no dead case in two groups， the incidence rate of postoperative complications and the hospital stay time in the observation group were significantly less than those of the control group (P < 0.05). Conclusion Before operation， oral fish oil fat emulsion support therapy before percutaneous transhepatic biliary stent placement operation can effectively improve the patient's liver function and nutritional status， promote the patients recovery， reduce complications occurred， it has very good application values.
[Key words] Malignant obstructive jaundice； Jaundice； Liver function； Fish oil fat emulsio
黃疸是由于血液中胆红素浓度增高，致使巩膜、黏膜、皮肤、体液出现发黄的症状，而恶性梗阻性黄疸是指胆胰系统肿瘤引起胆管梗阻所致的黄疸，可导致机体免疫功能低下和各脏器储备能力下降，也使得术后并发症和病死率的增加[1-2]。胆道梗阻影响营养物质的消化、吸收和代谢，研究表明大约50%的梗阻性黄疸患者合并营养不良[3-4]。当前各种减黄手术特别是经皮肝穿刺胆管引流术可降低手术的病死率，但是胆汁引流出体外可出现电解质失调、脂肪吸收和营养不良等，同时可能发生腹腔内出血、中毒性休克、胆汁性腹膜炎等并发症[5-6]。研究证实通过术前早期营养支持，可以促进患者的康复，并减少手术并发症的发生[7-8]。本文探讨经皮肝穿胆道支架置入减黄术前鱼油脂肪乳的应用方法与效果，现报道如下：, 百拇医药(刘承利 孔亚林 王成 张辉 赵刚 )
[关键词] 恶性梗阻性黄疸；减黄手术；肝功能；鱼油脂肪乳
[中图分类号] R730.5 [文献标识码] A [文章编号] 1673-7210(2017)02(b)-0110-04
[Abstract] Objective To investigate the application method and effect of fish oil fat emulsion before percutaneous transhepatic biliary stent placement. Methods From September 2013 to February 2016， in Air Force General Hospital of PLA， 156 patients with malignant obstructive jaundice were selected， according to radomnumber table， they were divided into observation group and control group， with 78 cases in each group. All patients were given percutaneous transhepatic biliary stent placement operation， the observation group were given oral fish oil fat emulsion support treatment， the patients in the control group were given intravenous infusion of fish oil fat emulsion support treatment， the support treatment was from 5 d before the operation to the day of surgery， the presentation of the two groups after operation were observed. Results The cumulative nitrogen balance in the observation group was significantly more than that in the control group (P < 0.05). The serum IL-6 and TNF-α in the observation group at postoperative 1， 12 d were significantly lower than those in the control group (P < 0.05)， and the serum IL-6 and TNF-α at postoperative 12 d were were significantly lower than those at the postoperative 1 d (P < 0.05). There was no dead case in two groups， the incidence rate of postoperative complications and the hospital stay time in the observation group were significantly less than those of the control group (P < 0.05). Conclusion Before operation， oral fish oil fat emulsion support therapy before percutaneous transhepatic biliary stent placement operation can effectively improve the patient's liver function and nutritional status， promote the patients recovery， reduce complications occurred， it has very good application values.
[Key words] Malignant obstructive jaundice； Jaundice； Liver function； Fish oil fat emulsio
黃疸是由于血液中胆红素浓度增高，致使巩膜、黏膜、皮肤、体液出现发黄的症状，而恶性梗阻性黄疸是指胆胰系统肿瘤引起胆管梗阻所致的黄疸，可导致机体免疫功能低下和各脏器储备能力下降，也使得术后并发症和病死率的增加[1-2]。胆道梗阻影响营养物质的消化、吸收和代谢，研究表明大约50%的梗阻性黄疸患者合并营养不良[3-4]。当前各种减黄手术特别是经皮肝穿刺胆管引流术可降低手术的病死率，但是胆汁引流出体外可出现电解质失调、脂肪吸收和营养不良等，同时可能发生腹腔内出血、中毒性休克、胆汁性腹膜炎等并发症[5-6]。研究证实通过术前早期营养支持，可以促进患者的康复，并减少手术并发症的发生[7-8]。本文探讨经皮肝穿胆道支架置入减黄术前鱼油脂肪乳的应用方法与效果，现报道如下：, 百拇医药(刘承利 孔亚林 王成 张辉 赵刚 )