食道癌病人术后营养支持方式探讨

Effect of postoperative nutritional support by different mode in patients with esophageal neoplasm

目的:观察不同营养支持方式对食道癌病人术后营养状态的影响,探讨食道癌病人术后合理的营养支持方案。方法:选择食道癌病人115例,术前随机分为肠外营养组(PN组,n=38)、肠内营养组(EN组,n=38)及肠外、肠内营养联合应用组(EN+PN组,n=39),同时将只进行常规补液的食道癌病人42例作为常规补液组。均于术后第1天开始给予营养支持或补液,分别于术后第1天、第8天测定营养相关指标并进行比较,再比较各组术后并发症发生率、营养支持平均费用、住院费用、肠道功能恢复时间以及术后住院天数等临床相关指标。结果:术后第8天4组病人体重均较术前下降,其中常规补液组和EN组下降幅度较大(P<0.05),而PN+EN组和PN组下降幅度较小(P>0.05),与常规补液组比较差异有统计学意义(P<0.05)。术后第8天PN+EN组和PN组病人血浆总蛋白、白蛋白、前白蛋白及血红蛋白水平均较术后第1天明显升高(P<0.05),且与常规补液组相比差异有统计学意义(P<0.05);术后第8天EN组病人的前白蛋白及血红蛋白水平较术后第1天明显升高(P<0.05),但低于PN+EN组和PN组(P<0.05),血浆总蛋白和白蛋白的水平高于常规补液组(P<0.05),但与术后第1天相比无明显升高(P>0.05);术后第8天常规补液组上述指标在术后第8天较术后第1天均无明显升高,血浆总蛋白和白蛋白的水平甚至低于营养支持前(P<0.05)。常规补液组切口感染发生率也高于其它3组(P<0.05)。PN组的日均营养支持费用、住院费用高于EN组和PN+EN组(P<0.05)。EN组和PN+EN组的肠道功能恢复时间短于PN组和常规补液组(P<0.05)。PN组、EN组和PN+EN组术后住院天数少于常规补液组(P<0.05)。结论:食道癌病人术后肠内、肠外营养联合应用可避免单用肠内或肠外营养支持的不足,并可降低手术和营养支持相关并发症,达到最佳的费用效益比。

Objective： To study the rational way of postoperative nutritional support by comparison with different nutritional support mode. Methods： One hundred and seventeen cases were randomized into three groups： parenteral nutrition （PN）group （n =38）, enteral nutrition （EN） group （n =38） and PN＋EN group （n =39）. Another 42 cases with only supported normal liquid were regarded normal liquid group. Body weight, serum total protein, albumin, prealbumin and hemoglobin, total lymphocytes count were monitored on the first preoperative day and first, eighth postoperative day. Hospital stay and cost were marked. Results： Their body weight was all decreased on the eighth postoperative day, but the decrease body weight of the normal liquid group was more than the PN＋EN and PN group （P 〈0.05）. Serum total protein, albumin, prealbumin and hemoglobin were significantly increased on the eighth postoperative day compared with the first postoperative day in the PN＋EN and PN groups （P 〈0.05）, and there were significant differences compared with normal liquid group （P 〈0.05）. Serum total protein and albumin were significantly decreased in the normal liquid group （P 〈0.05）. The EN group, although prealbumin and hemoglobin were significantly increased on the eighth postoperative day （P 〈0.05）, but were lower than that of the PN＋EN and PN groups （P〈0.05）. The hospital cost of PN group was significantly higher than that of EN and PN＋EN groups （P 〈0.05）. The hospital stay of PN, PN＋EN and EN group were significantly shorter than that of the normal liquid group （P 〈0.05）. Conclusion： Combined use of PN and EN can abstain from the shortcoming of only using the PN or EN in postoperative patients with esophageal neoplasm, and can help to maintain and improve the nutrition state and cut down the hospital stay and cost.