老年恶性消化道肿瘤患者术后应用肠内营养的安全性及疗效

Safety and Clinical Efficacy of Enteral Nutrition in Elderly Postoperative Patients with Malignant Gastrointestinal Tumor

目的评价老年恶性消化道肿瘤患者术后应用肠内营养支持的安全性及临床疗效。方法将108例老年恶性消化道肿瘤患者随机分为肠内营养(EN)组(45例)、肠外营养(PN)组(45例)及对照组(常规输液)组(18例),EN组术后24小时输注肠内营养液,PN组经外周静脉输注营养液。观察临床和测定营养支持前后患者的血糖、肝肾功能和电解质以及营养和免疫指标的变化。结果EN组肠功能恢复时间明显短于PN组和对照组(P<0·001);血糖、肝肾功能、电解质、补体C3、C4和总补体溶血活性在各组间差异无显著性;EN、PN组治疗后体重、前白蛋白、白蛋白、IgG、IgM、IgA及C-反应蛋白均显著高于对照组(P<0·05,P<0·01),而EN组与PN组间差异无显著性;EN组、PN组治疗后CD3+、CD4+、CD4+/CD8+均显著高于对照组(P<0·01),且EN组治疗后CD4+、CD4+/CD8+亦高于PN组(P<0·05)。结论肠内营养安全、实用有效,对体质差、年龄大的恶性消化道肿瘤患者更为适合。

Objective To explore the safety, feasibility and clinical efficacy of postoperative enteral nutrition in the elderly patients with malignant gastrointestinal tumor. Methods A total of 108 elderly patients with malignant gastrointestinal tumor were randomly divided into enteral nutrition （ EN, n = 45 ） , parenteral nutrition （ PN, n = 45 ）, and control （ n = 18 ） groups, and nutrition support was given 24 hours after surgery. Renal and liver functions, serum glucose, electrolytes, nutritional and immune parameters were evaluated before and after the treatment were compared. The restore status of the gastrointestinal functions and the complications were observed. Results The restoring time of intestinal movement was significantly decreased in EN group comparing with in PN group or in control group （P 〈0. 001 ）. Damage of EN to the renal and liver functions was not observed. The levels of body weight, prealbumin, albumin, IgG, IgM, IgA, and C-reactive protein in EN group or PN group were significantly higher than those in control group （P 〈0.05, P 〈0.01 ）, but had no statistical difference between EN group and PN group. The levels of CD3^＋ , CD4^＋ , and CD4^＋/CD8^＋ in EN group or PN group were significantly higher than those in control group （ P 〈 0.01 ）, while the levels of CD4^＋ , CD4^＋/ CD8^＋ in EN group was significantly higher than those in PN group （ P 〈 0.05 ）. Conclusion EN is an effectire, safe, and simple way to provide nutrition support in the postoperative elderly patients with malignant gastrointestinal tumor.