食管癌患者术后早期肠内营养的临床研究

Clinical Research on Early Postoperative Enteral Nutrition in Patients with Esophageal Cancer

目的研究食管癌患者术后早期肠内营养的实施方法、效果。方法对209例食管癌患者依据术后给予不同的营养支持方法分为两组,肠内营养组:146例,食管癌术后施行早期肠内营养;静脉营养组:63例,食管癌术后给予全静脉营养支持;比较两组患者术后并发症发生情况、术后恢复情况,检测手术后理化指标。结果两组患者术后均未发生吻合口瘘。术后并发症发生率肠内营养组明显低于静脉营养组(P<0.01),而肠内营养组腹泻发生率高于静脉营养组(P=0.000);术后肠鸣音恢复时间,肛门排气、排便时间和住院时间肠内营养组较静脉营养组短(P=0.000),住院费用、胃肠减压总量、胸腔引流液量亦较静脉营养组明显减少(P=0.000)。术后白蛋白、球蛋白、总蛋白量肠内营养组高于静脉营养组(P=0.000),而血尿素氮、肌酐和中性粒细胞数低于静脉营养组(P=0.000)。结论食管癌患者术后早期肠内营养是安全、有效、可行的,较静脉营养有明显的优势。

Objective To study the manageable methods, effect of early use of enteral nutrition after operations on esophageal cancer patients. Methods By different way of nutritional support after operation, 209 cases of esophageal cancer were divided into two groups in which enteral nutrition（EN） group,146 cases, were managed with early use of nutritional support through intestine and parenteral nutrition（PN） group, 63 cases, were given nutrition by way of veins. Complications, general recovery and blood biochemical criteria after operation between those two groups were compared. Results No cases of anastomotic fistula occurred in the two groups. The incidence of complications in EN group was significantly lower than that in PN group（P〈0.01）, and the occurrence of diarrhea was higher in EN group （P=0. 000）. The time needed for recovery of bowel sounds, anal exsufflation, defecation and hospital stay was shorter and hospital fee lower in EN group than those in PN group（P=0. 000）. The total amount of gastrointestinal and closed thoracic drainages decreased more significantly in EN group （P= 0. 000） and the value of albumin, globulin and total protein was significantly higher also in EN group （P = 0. 000）. But the amount of BUN, creatinine and neutrophil was significantly lower in EN group （P = 0. 000）. Conclusion Early use of enteral nutrition after operation on esophageal cancer is safe, effective and practical, with more significant advantages than those of parenteral nutrition.