| Objective:By grouping the patients with obstructive jaundice after operation, andtreated respectively with early enteral nutrition (EEN) and total parenteral nutrition (TPN),to observe the two kinds of nutrition on the prognosis in patients with obstructivejaundiceafter operation,to investigate the clinical effect and significance of early enteralnutrition after obstructive jaundice operation.Methods:40cases of the patients with obstructive jaundice after operation wererandomly divided into EN group and PN group in our hospital between February2012toFebruary2014.EN group was treated with early enteral nutrition, and PN group with totalparenteral nutrition,20patients in each group.Two groups of patients with equal calorieand nitrogen of nutritional support for7days.The specimen of blood were obtained beforoperation and on1st、3rd and7th day after operation to detect the level of serum albumin(ALB), prealbumin (PA), transferrin (Tf), alanine aminotransferase (ALT), aspartateaminotransferase (AST), alkaline phosphatase (ALP), γ-gamma glutamyl transferase(GGT), the plasma endotoxin and D-lactate.Calculating the daily nitrogen balance andaccumulative total nitrogen balance after operation.Record the numbers of cases ofpostoperative complications, intestinal function recovery time, treatment of the associatedcosts and postoperative hospitalization days.Results:The differences of the level of serum prealbumin, albumin and transferrinwere not statistically significant in the two geoup whether between or within groupcomparisons(P>0.05). Compared with pre-operation, thelevel of prealbumin and transferrin decreased in the1st day after operation, then rising with the time, and EN group increasedmore than PN group; The two groups of liver enzymes were decreased after operation, butthe recovery speed in EN group faster than in PN group, and GGT in eighth days afteroperation had a significant difference between the two groups (P<0.05); from the first dayafter operation,nitrogen balance in the two groups were all negative (P>0.05), from the3rdday after operation in group EN, nitrogen balance was better than PN group (P<0.05),7thday after operation in the EN group accumulated nitrogen balance was positive, but groupPN’nitrogen balance was negative, two groups of patients after seven days of accumulatednitrogen balance have significant difference (P<0.05); compared with thepre-operation,two groups of endotoxin and D-lactate increased significantly after operation(P<0.05), and decreased gradually with time. EN group decreased faster than that of PNgroup.7th day after operation, the level of endotoxin and D-lactate in EN group wassignificantly lower than the level in1st day after operation (P<0.05), and close topreoperative levels. But the level of endotoxin and D-lactate of PN group each phase werehigher than the pre-operation(P<0.05), and higher than the level of EN group;7th day afteroperation, group EN endotoxin level was significantly lower than PN group; the incidenceof gastrointestinal adverse reactions in EN group were higher than those in PN group, andoperation complications were lower than those of PN group, butthehe were not statisticalsignificance differences (P>O.05). Postoperative anal exhaust time was significantlyshorter in group EN (P<0.05), time of hospitalization than PN group slightly shortened(P>0.05); nutrition treatment costs and the cost of hospitalization was significantly lowerthan that in PN group (P<0.05).Conclusions:Obstructive jaundice patients treated with early enteral nutrition afteroperation can improve the nutritional and metabolic status,and it is to be safe and effective;can effectively ptotect intestinal barrier function（TBF）, there will be significant to theprevention of intestinal bacterial endotoxin translocation(BET) and infection complication;and can promote the recovery of gastrointestinal function, shorten the time ofhospitalization, reduce hospitalization expenses. |
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