营养支持对肠外瘘患者入院初期人体组成的改善作用

观察肠外瘘患入院初期营养支持对人体组成的改善作用。30例肠外瘘患分成两组各15例，分别给予全肠外营养支持(TPN)或全肠内营养支持(TEN)，观察10d前后患人体组成、血清胰岛素样生长因子—1(IGF—1)及血清蛋白浓度的变化。结果发现，所有患的人体体质指数(BMI)与体细胞群(BCM)均有显改善，而且TEN组患BCM增加幅度更明显，两组患总体水(TBW)与细胞内水(ICW)均增加，尤其是ICW差异显，而细胞外水(ECW)没有明显变化。TEN组患的血清前白蛋白有显改善，而两组患的血清IGF—1均有显上升，TEN组患IGF—1增加幅度更明显；IGF—1的变化与FFM、BCM、ICW、TBW的改善显相关，营养支持治疗显改善肠外瘘患入院初期的体细胞群，迅速增加细胞内水量，纠正细胞内外水的异常分布，而且肠内营养支持可以比肠外营养支持更明显地促进肠外瘘患人体组成的改善。

Responses of Body Composition to Early Nutritional Support in Patients with Enterocutaneous Fistula

To investigate the responses of body composition to nutritional support in a group of patients with enterocutaneous fistula after admission to our hospital, thirty patients with enterocutaneous fistula were divided into TPN-fed group or TEN-fed group according to intestinal function and the body composition was measured by multiplefrequency bioelectrical impedance analysis just before nutritional support and 5 or 10 days later. Sequential measurements of plasma constitutive proteins and insulin-like growth factor-1 were also measured. The analysis of body composition was also carried out in thirty volunteers as control. The body mass index and body cell mass of the patients were significantly improved in 10 day. Once the patients received nutrition supplement, ICW began to greatly rise up by day 5 in all patients. Although there was an amelioration of plasma constitutive protein synthesis, the plasma prealbumin gained significant changes in TEN-fed patients. Plasma IGF-1 levels increased in either group and were correlated to the improvements in FFM, ICW, TBW, and BCM, especially in TEN-fed patients. The early nutritional intervention rapidly ameliorated the abnormal distribution of body water, preventing the further deterioration of cellular composition in patients with enterocutaneous fistulas. There were much more significant improvements in body cell mass and plasma IGF-1 levels in TEN-fed patients than those in TEN-fed patients.