中国临床药学杂志

目的 分析肠内和肠外营养对儿童肝移植患者术后肝功能、营养状况及并发症的影响。方法 选取2022年12月至2025年12月收治的儿童肝移植病例43例，根据围术期营养支持方式分为肠内营养组（EN组，25例）和肠内联合肠外营养组（EN+PN组，18例）。比较2组术前1 d、术后1 d、术后7 d和术后14 d的肝功能（丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素和直接胆红素水平）、营养状况（白蛋白和前白蛋白水平）、术后并发症的发生情况和重症监护室住院时间。结果 在营养状况和并发症方面，2组术前1 d、术后1 d、术后7 d和术后14 d的白蛋白水平、前白蛋白水平、感染发生率和胆道并发症发生率比较差异无统计学意义（P > 0.05）。在肝功能方面，EN+PN组术后1 d的丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平高于EN组（P<0.05），其他时间点2组丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平比较差异无统计学意义（P > 0.05）;EN+PN组术后7 d的丙氨酸氨基转移酶水平高于术前1 d(P<0.05)。EN+PN组重症监护室住院时间长于EN组（P<0.05）。结论 肠内和肠外联合肠内营养在营养状况的维持和并发症发生率方面效果相似，但添加肠外营养可能会导致肝功能一过性异常、丙氨酸氨基转移酶恢复延迟及重症监护室住院时间延长。儿童肝移植围术期如无明显肠内营养禁忌，应予充分的肠内营养支持，如肠内营养无法满足需求，可适当添加肠外营养。

AIM To analyze the effects of nutritional support methods on liver function, nutriture and complications after liver transplantation. METHODS A total of 43 pediatric liver transplant patients admitted from December 2022 to December 2025 were selected and divided into enteral nutrition group(EN group, 25 patients) and enteral nutrition combined parenteral nutrition group(EN+PN group, 18 patients) according to different nutrition methods during the perioperative period. Changes in liver function, including levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TB) and direct bilirubin(DB), as well as changes in nutrition, including levels of albumin(ALB) and prealbumin(PAB), were compared between 2 groups at the following times: 1 day before surgery, 1 day after surgery, 7 days after surgery and 14 days after surgery. The effects of different nutritional methods on postoperative complications and length of stay in the intensive care unit(ICU) were also compared. RESULTS There was no statistically significant difference in nutritional status, including ALB and PAB levels, infection rate, and biliary complication rate between the 2 groups(P > 0.05). In terms of liver function, the ALT and AST levels of the EN plus PN group were higher than those of the EN group 1 day after surgery(P < 0.05), and there were no statistically significant differences in ALT and AST levels between 2 groups at other time points(P > 0.05). The ALT level of the EN plus PN group 7 days after surgery was higher than that 1 day before surgery(P < 0.05). The ICU stay in the EN plus PN group was significantly longer than that in the EN group(P < 0.05). CONCLUSION EN and EN plus PN have similar effects in maintaining nutritional status and the incidence of complications. However, the addition of PN may lead to transient liver function abnormalities, delayed ALT recovery, and prolonged ICU stay. If there are no obvious contraindications to EN in the perioperative period of pediatric liver transplantation, adequate EN support should be provided. If EN is unable to meet the needs, PN can be appropriately added.