老年食管贲门癌术后营养支持治疗的探讨

A clinical study on different nutritional support in the early post-operative stage of the elderly patients with esophagocardial carcinoma

目的寻找老年食管贲门癌患者术后早期营养支持的理想途径。方法将220例老年食管贲门癌患者随机分成肠内营养组(EN)和肠外营养组(PN),监测所有患者术前1天,术后第4、11天血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TF)及IgA、IgG、IgM,留取24 h尿测定尿素氮,计算氮平衡,观察患者术后恢复情况,记录肛门排气时间、术后并发症、平均住院日及消化道不良反应等,并做统计学分析。结果治疗10 d后各组营养指标、免疫指标均有增高,但EN组水平明显高于PN组(P<0.01);临床观察EN组肛门排气时间较PN组显著缩短(P<0.05),术后并发症减少,平均住院时间缩短。结论早期肠内营养支持能促进肠功能恢复,显著改善营养状况,增加机体免疫功能,减少术后并发症,缩短住院时间,较肠外营养更有效,更适用于老年食管贲门癌患者。

Objective To explore the ideal approach of the nutritional support in the early post-operative stage of the elderly patients with esophagocardial carcinoma. Methods 220 elderly patients with esophagocardial carcinoma were divided into two groups：the parenteral nutrition group（PN） and the enteral nutrition group （ EN ）. Seralbumin （ ALB ）, prealbumin （ PA ）, transferrin （ TF）, immunoglobulin A, immunoglobulin G, immunoglobulin M and nitrogen balance in all patients were monitored before operation and 4,11 days after operation. The time of passage of gas by anus, post-operative complications, average days of hospital stay were also observed and analyzed. Results The indexes of the patients＇ nutrition and immunity were improved in the two groups, but group EN was better than group PN, and the time of passage of gas by anus was shorter in group EN than in group PN. Conclusion Enteral nutrition in the early post-operative stage of the elderly patients with esophagocardial carcinoma would hasten the recovery of intestinal function, and improve the nutritional status and the immune function significantly. It can also reduce the post-operative complications, and shorten the length of hospital stay. The beneficial effect in group EN is greater than that in group PN, particularly in the elderly patients.