胃癌术后早期肠内营养的意义

Early enteral nutrition after surgery of gastric cancer

目的探讨胃癌术后早期肠内营养(EN)的安全性和有效性。方法采用随机对照的方法,将68例胃癌术后患者随机分为EN组和肠外营养组(PN组),分别经鼻肠管、经颈内静脉进行营养支持,观察两组患者消化道并发症的发生情况、继发感染情况以及术后白蛋白、前白蛋白、淋巴细胞计数等。结果EN组术后腹胀、腹泻的发生率较PN组,但患者均能耐受。EN组1例患者因吻合口水肿、输入襻不完全性梗阻而发生恶心、呕吐,余患者无恶心、呕吐；PN组发生肺部感染和导管感染各1例。EN组肛门排气、排便时间早于PN组(P=0．01)。与PN组比较,EN组术后白蛋白略有下降,前白蛋白升高。结论早期EN可降低术后感染的发生率,有利于胃癌患者术后的恢复。

Objective To appraise the utility and safety of early enteral nutrition in gastric cancer patients after surgery. Methods A randomized controlled clinical trial was conducted comparing the role of early enteral nutrition（EN） group with total parenteral nutrition（PN） group in 68 gastric cancer patients after operation. The nutritional data, infections rate and enteral nutrition-associated complications were analyzed and compared between the two groups. Results After 1 week, the albumin, pre albumin, frequency of abdominal distension and diarrhea in EN group were higher than those in PN group, but rather tolerable; whereas the infection rate in EN group was lower. The onset of functional gut recovery in EN group was earlier. With 1 case of nausea and vomiting caused by incomplete efferent loop obstruction of edematous stoma. Still more, EN group showed earlier anal gas passing and defecation, slight decrease of albumin and increase of prealbumin than those of the PN group. Conclusion EN can accelerate the recovery of nutritional and gut function after surgical operation; and also reduce the infection rate in comparing with PN.