术后早期肠内营养对老年胃癌病人术后康复和心率变异性的影响

Effects of early postoperative enteral nutrition on postoperative rehabilitation and heart rate variability in elderly patients with gastric cancer

目的:探讨术后早期肠内营养(EN)对老年胃癌病人术后康复和心率变异性的影响。方法:纳入2018年5月至2022年5月在蚌埠医学院第一附属医院接受胃癌根治术的病人。依据术后是否采用术后早期EN治疗分为观察组(EN组)和对照组(非EN组)。观察组病人给予EN治疗[20~30 kcal/(kg·d)]。比较两组术后康复和营养状况,以及短时心率变异性(st-HRV)参数,包括:5min相邻R波(RR)间距标准差均值(SD)、连续RR间距差异平方根(RMSSD)以及相邻RR间距相差>50毫秒比例(PNN50)。结果:共纳入对照组45例,观察组38例。观察组病人术后5 d白蛋白(ALB)(t=3.082;P=0.003)和前白蛋白(PAB)(t=23.230;P <0.001)水平均显著高于对照组。观察组病人术后首次排气时间(t=5.321,P <0.001)、恢复正常饮食时间(t=2.944,P=0.004)以及术后住院日(t=2.305,P=0.024)均显著短于对照组病人。两组病人术后5 d st-HRV参数均显著大于对照组病人,包括:SD(t=15.040,P <0.001)、RMSSD(t=26.070,P <0.001)和PNN50(t=5.018,P <0.001)。病人术后5 d ALB水平和stHRV参数SD(r=0.620;P <0.001)、RMSSD(r=0.501;P <0.001)和PNN50(r=0.730;P <0.001)均呈现显著正相关关系。结论:术后早期EN能够促进胃癌病人术后康复并改善过低水平的心率变异性。

Objective: To investigate the effects of early postoperative enteral nutrition(EN) on postoperative rehabilitation and heart rate variability in elderly patients with gastric cancer. Methods: Patients who underwent radical gastrectomy for gastric cancer in the First Affiliated Hospital of Bengbu Medical College from May 2018 to May 2022were included. The patients were divided into the observation group(EN group) and the control group(non-EN group)according to whether postoperative early enteral nutrition was used or not. The patients in the observation group were given EN treatment(20 ~ 30 kcal/kg/d). The postoperative rehabilitation and nutritional status of the two groups were compared, as well as short-term heart rate variability(st-HRV) parameters, including: 5-minute adjacent R wave(RR)interval standard deviation mean(SD), continuous RR interval difference square root(RMSSD) and the ratio of adjacent RR spacings that differ by > 50 ms(PNN50). Results: A total of 45 cases in the control group and 38 cases in the observation group were included. The levels of albumin(t = 3.082;P = 0.003) and prealbumin(t = 23.230;P < 0.001) in the observation group were significantly higher than those in the control group at 5 days after operation. The time to first exhaust after operation(t = 5.321, P < 0.001), the time to return to normal diet(t = 2.944, P = 0.004), and the postoperative hospital stay(t = 2.305, P = 0.024) in the observation group were significantly shorter than those in the control group. The st-HRV parameters of the observation group were significantly greater than those of the control group at 5 days, including: SD(t = 15.040, P < 0.001), RMSSD(t = 26.070, P < 0.001) and PNN50(t = 5.018, P < 0.001).There was a significant positive correlation between albumin level and st-HRV parameter SD(r = 0.620;P < 0.001),RMSSD(r = 0.501;P < 0.001) and PNN50(r = 0.730;P < 0.001) 5 days after the operation. Conclusion: Early postoperative EN could promote postoperative recovery and improve heart rate variability in patients with gastric cancer.