Study On The Application Of Perioperative New Olive Oil Fat Emulsion Parenteral Nutrition Combined With Enteral Nutrition On The Enhanced Recovery After Hepatectomy

Objective The clinical data and short-term prognosis of patients with primary liver cancer(HCC)after hepatectomy were prospectively analyzed.By comparing the new olive oil fat emulsion for parenteral nutrition combined with enteral nutrition,and regular soybean oil long chain fat emulsion with enteral nutrition,the differences in postoperative recovery,complications,laboratory examination and general situation at discharge were analyzed,so as to explore the value and advantages of applying new olive oil fat emulsion combined with enteral nutrition to promote the enhance recovery after hepatectomy.Methods 1.A total of 48 HCC patients who were admitted to the First Central Hospital of Tianjin from 2018.12 to 2020.2 were enrolled.2.Randomized grouping method was used to divide the patients into the experimental group and the control group,24 patients in each group.Patients in the experimental group were given 10%fat emulsion(OO)5.5%amino acid(15)glucose(20%)injection(trade name:klinmei,Guangzhou baiteqiaoguang medical supplies Co.,Ltd.)three days before the operation.The early postoperative(after the recovery of gastrointestinal function)was given special enteral nutrition suspension TP-MCT(trade name kangquangan,Netherlands newdigia company)(consistent with the total amount of the control group);the control group were given free low fat diet before the surgery,and received soybean oil long-chain fat emulsion(trade name intelipit,Huarui Pharmaceutical Co.,Ltd.)intravenously three days after the operation.Administration of TP-MCT(trade name:kangquangan,nedia)was given in early postoperative period.3.Preoperative general indexes,postoperative complications,postoperative nutritional status,liver function,humoral,cellular immune status and inflammatory factor levels were compared between the experimental group and the control group.4.The advantages and disadvantages of the new olive oil fat emulsion for parenteral nutrition combined with enteral nutrition in perioperative period and the advantages and disadvantages of regular soybean oil long chain fat emulsion with enteral nutrition were evaluated.5.SPSS23.0 statistical software was used for data statistics.If the measurement data of the experimental group and the control group obey the normal distribution,the Student-t test or ANOVA test shall be used;the?2 test shall be adopted for the two groups of classification and counting variables;the indexes of the two groups such as stage classification conform to the ordered variables,and the univariate analysis of variance shall be adopted between the groups.All the statistics were tested by two-sided test,the test level was a=0.05,P<0.05,the difference was statistically significant.Results 1.The average age of the patients in the control group was(64.96±11.64)years old,the average age of the patients in the experimental group was(63.72±10.92)years old.There were no significant differences between the two groups in nutritional status(BMI,sebum thickness),liver function(Child-pugh grade,MELD score,ICG-R15)and PS-ECOG score of patients with tumor(all P>0.05).2.There were no significant differences in the incidence of complications such as dysuria,pneumonia,incision infection,bile fistula and bleeding between the experimental group and the control group(P>0.05),and there was a significant difference in the incidence of nausea,vomiting,diarrhea and postoperative complications(P<0.05).3.There was no significant difference in the preoperative nutrition index BMI and the thickness of sebum between the experimental group and the control group.The BMI and the thickness of sebum in the experimental group were higher than those in the control group on the 7th day after operation,but had no statistic different(P>0.05).There was no significant difference in ALB and PAB between the two groups on the 1st day before operation and the 1st day after operation(P>0.05).The level of serum albumin and prealbumin in the experimental group were significantly higher than those in the control group on the 3rd and 7th day after operation(P<0.05).4.There were no significant differences in ALT,AST,ALP,LDH,DBIL,IBIL,PT and APTT between the experimental group and the control group on the first day before operation(P>0.05);there was no differences between the experimental group and the control group in ALT,AST,ALP,LDH,DBIL,IBIL,PT and APTT on the first day after operation(P>0.05).There were significant differences in AST,ALT,LDH,IBIL and APPT on the 3rd and 7th day after operation(P<0.05).5.There was no significant difference(CD4~+,CD8~+,Ig G,Ig M,Ig A,TNF-a,IL-6,CRP)in the levels of cellular immunity,humoral immunity and inflammatory factors between the experimental group and the control group on the first day before and after operation(P>0.05);the proportion decreased of CD4~+and CD8~+cells in the experimental group was lower than that in the control group on the third day after operation(P<0.05).At the seventh day,there were differences in CD4~+,CD8~+cells,Ig G,IL-6 and CRP between the two groups(P<0.05);there were no differences in Ig M and Ig A in humoral immunity.Conclusions The new olive oil fat emulsion for parenteral nutrition combined with enteral nutrition is helpful to reduce the incidence of nausea,vomiting,diarrhea,as well as the incidence of postoperative complications in patients with liver cancer after hepatectomy.Compared with the traditional soybean oil fat emulsion parenteral nutrition combined with enteral nutrition,it is more conducive to the recovery of nutritional status of patients after hepatectomy;it is more conducive to the recovery of liver function index of patients after hepatectomy;it is more conducive to the recovery of cellular immune,humoral immune and inflammatory factor levels of patients after hepatectomy.