摘要目的:探讨肝硬化食管胃底静脉曲张破裂出血内镜治疗后超早期肠内营养支持的安全性及结局分析。方法:回顾性纳入2018年1月至2022年1月在北京市海淀医院消化内科诊治的肝硬化食管胃底静脉曲张破裂出血并接受内镜下治疗的患者。按照术后恢复进食时间分为超早期肠内营养组（内镜止血治疗后4小时恢复肠内营养）和常规方法营养组（术后至少48小时后启动肠内营养，期间给予肠外营养支持）。观察比较两组患者内镜治疗术后6周再出血情况、感染情况（包括肺部感染、泌尿系感染、自发性细菌性腹膜炎等）、住院时间及再住院率等。结果:共纳入96例患者，其中超早期肠内营养组52例、常规方法营养组44例，两组之间年龄、性别、体重指数、肝硬化病因、Child-Pugh分级、内镜下食管胃静脉曲张LDRf分型、食管静脉曲张严重程度分级差异无统计学意义（ P>0.05）。所有患者随访6周，超早期肠内营养组和常规方法营养组之间再出血（5.8%比4.5%， P>0.999）、自发性细菌性腹膜炎（1.9%比4.5%， P=0.883）、肺部感染（5.8%比11.4%， P=0.537）、泌尿系感染（3.8%比2.3%， P>0.999）发生率差异均无统计学意义。非劣效性分析显示，术后超早期肠内营养不发生再出血的安全性非劣效于常规营养方法（ P=0.0018）。超早期肠内营养组住院天数明显小于常规方法营养组（6天比9天， P<0.01）。超早期肠内营养组6周内再住院率相对低于常规方法营养组，但差异无统计学意义（3.8%比9.1%， P=0.526）。 结论:肝硬化食管胃底静脉曲张破裂出血内镜治疗后早期恢复肠内营养不增加再出血风险，且可缩短住院时间。

abstractsObjective:To investigate the safety and clinical outcome of ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients.Methods:Cirrhotic patients with gastroesophageal variceal bleeding who received endoscopic treatment at the Endoscopic Center of Beijing Haidian Hospital were retrospectively included from January 2018 to January 2022. The patients were divided into ultra-early oral nutrition group where patients would fast for 4 hours after endoscopic treatment and routine treatment group where patients would fast for at least 48 hours after operation and receive parenteral nutrition during fasting. The rebleeding, infection events (including pulmonary infection, urinary infection, spontaneous bacterial peritonitis, etc.), hospitalization duration and hospital readmission were recorded and compared between the two groups.Results:A total of 96 patients were enrolled, including 52 with ultra-early oral nutrition, 44 with routine treatment. There was no significant difference in age, gender, BMI, cause of liver cirrhosis, Child-Pugh score, LDRf classification of gastroesophageal varices and degree of esophageal varices between the two groups ( P > 0.05). All patients were followed up for 6 weeks and there was no significant difference in incidence of rebleeding (5.8% vs 4.5%, P > 0.999), peritonitis (1.9% vs 4.5%, P = 0.883), pulmonary infection (5.8% vs 11.4%, P = 0.537) and urinary infection (3.8% vs 2.3%, P > 0.999) between the two groups. The non-inferiority analysis suggested that the safety defined as free from rebleeding in ultra-early oral nutrition group was not inferior to that in routine treatment group ( P = 0.0018). The hospitalization duration in ultra-early oral nutrition group was significantly shorter than that in routine treatment group (6 days vs 9 days, P < 0.001). The hospital readmission rate within 6 weeks in the ultra-early oral nutrition group tended to be lower than that in the routine treatment group (3.8% vs 9.1%, P = 0.526). Conclusion:Ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients shows similar rebleeding risk compared with current practice and can shorten hospitalization duration.