【摘要】 目的 探讨强化益生元膳食纤维的肠内营养在腹部外科术后患者中的临床应用。 方法 2008年7月-2010年11月30例接受腹部外科中等以上手术的患者术前随机分为研究组和对照组，每组15例。研究组患者于术后接受肠内营养，并予以强化益生元膳食纤维；对照组只接受相同的肠内营养支持。观察指标为术后感染并发症、胃肠道并发症、住院时间、抗生素治疗时间、C反应蛋白水平和病死率等。 结果 研究组术后住院时间为（10±5） d，对照组为（15±7） d，两组差异有统计学意义（t=2.251，P=0.033）；研究组C反应蛋白水平为（6.6±3.2） mg/L，对照组为（9.8±2.1） mg/L，两组差异有统计学意义（t=3.238，P=0.003）；研究组抗生素治疗时间为（5.0±3.5） d，对照组为（6.0±4.8） d，两组差异无统计学意义（t=0.652，P=0.520）。两组均无死亡病例；术后研究组2例发生感染并发症，对照组3例，两组感染并发症发生率差异无统计学意义（P=1.000）。两组患者均能耐受经肠内补充营养素。 结论 与常规肠内营养比较，给予强化益生元膳食纤维的肠内营养能减少腹部外科术后患者的住院时间，降低急性期炎症反应。【Abstract】 Objective To investigate the effect of early enteral supply of prebiotic fiber in patients undergoing major abdominal surgery. Methods Between July 2008 and November 2010, 30 patients undergoing major gastrointestinal surgery were randomized into the study group and the control group before operation with 15 patients in each group. Prebiotic fiber was administered combined with enteral nutrition support for patients in the study group. Patients in the control group only received conventional enteral nutrition without fiber. The main endpoints included the development of bacterial infection, the duration of hospital stay, antibiotic therapy, the serum level of C-reaction protein (CRP), side effects of the enteral nutrition and morbidity. Results Compared with the control group, the median duration of hospital stay was shorter in the study group [(15±7) days in the control group vs. (10±5) days in the study group; t=2.251, Plt;0.05]. The mean level of CRP was also lower in the study group [(6.6±3.2) mg/L] than that in the control group [(9.8±2.1) mg/L] (t=3.238, Plt;0.05). The enteral nutrition and fibers were well tolerated. The incidence of infectious complications (3 cases in the control group vs. 2 cases in the study group) and the median duration of antibiotic therapy [(6.0±4.8) days in the control group vs. (5.0±3.5) days in the study group] were not significantly different between the two groups (t=0.652, Pgt;0.05). No patients died in both the two groups. Conclusion Compared with the conventional enteral nutrition, early enteral supply of prebiotic fiber can reduce the duration of hospital stay and acute phase response.
Objective To investigate the influence of preoperative enteral nutrition with dietary fiber on the nutritional status of patients with colon colostomy diaplasis, and discuss its safety. Methods Forty preoperative colon colostomy diaplasis patients from West China Hospital treated between September 2013 and June 2014 were randomly assigned into trial group and control group with 20 in each. The baseline of the two groups was the same (all P > 0.05). The trial group was given enteral nutrition with dietary fiber before operation for seven days, while control group was given homogenate diet with equal quantity of energy and nitrogen content for the same period of time. All patients were being tested for nutritional indexes on the day of admission and on the fifth day after surgery. Meanwhile, other indexes such as the first time of flatus and defecation, abdominal distension, bellyache, and other adverse reactions were recorded too. Results There was no statistical difference in nutritional indexes on the day of admission and on the fifth day after surgery between two groups (P > 0.05). Patients with dietary fiber had significantly higher incidence of abdominal distension than the control subjects (P < 0.05), but other adverse reactions had no statistical differences between the two groups (P > 0.05). No anastomotic leakage occurred in both the two groups. Patients with dietary fiber had significantly earlier time of flatus than the control group (P < 0.05). Patients with dietary fiber had significantly lower incidence of diarrhea than the control subjects (P < 0.05). Conclusions The study suggests that it is safe and feasible to use enteral nutrition with dietary fiber for preoperative colon colostomy diaplasis patients. Using dietary fiber is helpful for intestinal function recovery and reduction of the occurrence of adverse reactions after surgery.