消化道恶性肿瘤患者术后早期肠内营养支持的应用评价

Efficacy assessment of early enteral nutrition intervention in patients with alimentary tract carcinoma after surgery

目的探讨消化道恶性肿瘤术后早期肠内营养与肠外营养在术后并发症以及医学经济学方面的差异。方法对2003年9月全2005年12月我院普通外科住院的164名消化道恶性肿瘤患者术后进行营养支持干预,其中84例(EN 组)采用术后早期肠内营养(24～48 h 内),80例(TPN组)采用肠外营养治疗,分别比较两组患者术后7～10 d 的营养指标变化、肛门排气、胃排空恢复时间、术后住院日和总住院费、并发症发生率。结果 EN 组术后第7天血清前白蛋白(309±49)mg/L,高于 TPN 组的(277±46)mg/L(P<0.05)。EN 组肛门排气时间、胃排空恢复时间、平均术后住院时间分别为(54±17)h、(7.1±2.8)h 和(18±6)d,均显著低于 TPN 组的(75±15)h(P<0.05)、(13.1±6.7)h(P<0.01)和(21±4)d(P<0.05)。EN 组的营养支持并发症发生率和总住院费分别是19.0%和16 376.60元,显著低于 TPN 组37.5%和23 748.50元(P<0.01)。结论消化道恶性肿瘤患者术后给予早期肠内营养比单纯肠外营养安全可靠、简便,更符合正常生理状态,对胃肠功能恢复有利,且相关并发症少,费用更低廉。

Objective To study the difference in occurrence of complications and health economics between early enteral nutrition （EN） and total parenteral nutrition （TPN） in patients with alimentary tract carcinoma after surgical operation. Methods Totally, 164 patients with alimentary tract carcinoma hospitalized at the Department of General Surgery in China-Japan Friendship Hospital, Beijing during September 2003 to December 2005 with nutritional intervention, 84 cases with early EN and 80 with TPN within 24 to 48 hours after surgical operation, were reviewed. Nutrition index, complications, recovery of gastrointestinal movement, length of hospital stay after operation and total cost of the patients were analyzed. Results Serum level of prealbumin in EN group was （309 ± 49） mg/L, significantly higher than that in TPN group of （ 277 ±46 ） mg/L （ P 〈 0. 05 ） on the 7th day after surgery. Anal aeroflux restored at （54 ±17） h, gastric evacuation restored at （7. 1 ±2. 8） h in average after operation, and average length of hospital stay was （ 18 ± 6 ） d in EN group, significantly lower than those in TPN group （ 75 ± 15 ） h （P〈0.07）, （13.1 ±6.7） h （P〈0.01） and （21 ±4） d （P〈0.05）, respectively. Occurrence of complications caused by nutritional intervention was 19. 0 percent, and total cost of hospitalization was （16 376. 60） RMB yuan per patient in average in EN group, significantly less than those in TPN group （37.5 percent and 23 748.50 yuan, respectively）, P 〈 0. 01. Conclusions Early EN for patients with alimentary tract carcinoma after surgical operation is safer, more simple, more feasible and in line with their physiological status, which is beneficial to their quick recovery of gastrointestinal function with lower occurrence of complications and less cost, as compared to those in TPN group.