Affection Of The Gastrointestinal Function’s Recovery After Liver Transplantation And Early Enteral Nutrition Strategy

ObjectivesAimed to choose means for people who got enteral nutrition supporting; to usestandardized management strategy for early enteral nutrition after liver transplantationpatients intented to offer assessment, nursing intervention guidance.Methods1. There were259liver transplantation patients in two hospitals of Fujian provincefrom January2004to October2009.To descriptive analysis the time ofgastrointestinal function’s recovery in liver transplantation patients. The pipe or oralnutrition supplement diet totally reached three consecutive days over30ml/Kg bodyweight/day. It met the need of the first day as the full recovery of gastrointestinalfunction.This study was divided into three groups(≤7days group、7~14days groupand>14days group)aimed to observe the incidence of postoperative complications,length of hospital days and costs in hospital in each group. This study was designed totwo groups (≤7days group and>7days group) for the recovery of gastrointestinalfunction. Logistic regression analysis was used to analyze the risk factors ofrecovery of gastrointestinal functions during the preoperative and intraoperativeperiods. According to the ways of enteral nutrition after liver transplantation weredivided into the nasogastric tube group and percutaneous gastrojejunostomy tubegroup.The highest risk factors for MELD score was stratified to observe the feedingtube beginning time, pipeline-related complications, length of stays and costs duringhospitalization.2. From November2010to2011December,there were47cases of early enteralnutrition in postoperative standardization of liver transplant recipients (interventiongroup), From October2009to October2010there were40cases of early enteralnutrition in postoperative normalization of liver transplant recipients (controlgroup).Both of them were used percutaneous gastrojejunostomy tube feeding. Beforethe choice of cases a balanced test statistical difference was to do between two groups. All cases were analyzed to observe the enteral nutrition in patients with intoleranceindexes,serum albumin,prealbumin,three days blood glucose levels.3.Statistical analysis: This study was designed to use SPSS11.5software for statisticalanalysis such as the t test、ANOVA analysis etc.Some of the data was to use theFisher exact method.The recovery of gastrointestinal function related factors logisticregression analysis was considered statistically significant difference (P<0.05).Results1.To descriptive statistical analyze the gastrointestinal function of the liver transplantrecovery timeAfter7days,14days, patients reached55.91%and91.34%respectively.7dayspatients with full recovery of gastrointestinal function compared with7~14daysgroup and>14days group had a lower lung, abdominal, incisional infectioncomplications, serum total bilirubin level and had a higher serum albumin level. Thedifferences were statistically significant (P <0.05). Postoperative hospitalization timecosts was differed from three groups, the differences were statistically significant (P<0.05). Renal dysfunction and acute rejection were no significant differences in eachgroup(P>0.05).Further Multivariate Logistic regression analysis was showed that thefour risk factors related to gastrointestinal function recovery were preoperative MELDscore, blood loss, ascites and hepatic portal occlusion time.Percutaneousgastrojejunostomy tubes nutrition started time was significantly ahead of schedule (P<0.001), feeding tube use of time extension (P<0.001), postoperative3days to7daysthrough the feeding tube supplement were significantly increased (P <0.001). MELDscore over15points, percutaneous gastrojejunostomy tubes gastric retention stay(P=0.035), pipeline accidents prolapse incidence (P=0.037), hospitalization days andpostoperative hospitalization costs were significantly lower than the nasogastric tubegroup (P <0.05), while the incidence of diarrhea and pipeline blockage were nosignificant differences (P>0.05). Cases of different MELD score between the twogroups lung infection, abdominal infection, acute renal failure and acute rejectionwerewere no significant differences (P>0.05).2.The standardized enteral nutrition analysis Standard time of gastrointestinal nutrient levels in the intervention group was6.94±0.98days, significantly lower than the control group,8.67±0.58days (P <0.001), thedifference was statistically significant; the intervention group the incidence ofdiarrhea was significantly lower than the control group, the difference wasstatistically significant (P=0.032); three days before the blood glucose level changeswas statistically significant (P<0.001); the various indicators such as prealbumin andalbumin were no significant differences (P>0.05).Conclusions: There was a higher incidence for patients after liver transplantationgastrointestinal function’s recovery, and might result in postoperative infectioncomplications,rise the incidence of hospital days, and increase the hospital costs. Thefour risk factors related to gastrointestinal function recovery were preoperative MELDscore, blood loss, ascites and hepatic portal occlusion time. Patients after livertransplantation with MELD score over15points had the merits of early enteralnutrition after percutaneous gastrojejunostomy tube. Compared with early enteralnutrition normal management, Using standardized enteral nutrition care managementstrategies had its advantages such as reducing diarrhea rates, etc.