胃癌行全胃切除术后早期肠内营养的临床研究

Clinical research of early enteral nutrition after gastrectomy of gastric carcinoma

目的研究胃癌行全胃切除术后早期肠内营养支持的安全性、可行性及应用价值。方法90例胃癌行全胃切除术的患者,随机分为三组,每组30例,普通输液组(对照组)、早期接受肠内营养组(EN组)、肠外营养组(PN组),EN组术后24 h开始行肠内营养治疗,营养支持连续7 d,三组热量基本相等,并对三组病人进行术前、术后第8 d营养状态评价,比较术后肠功能恢复及住院天数、住院费用等。结果三组血浆蛋白、前白蛋白、体重均较术前下降,以对照组显著,前白蛋白PN、EN组升高有显著性(P<0.01);术后肠道功能恢复以EN组最快;术后并发症发生率以对照组为高;住院时间以对照组最长;治疗费用PN明显高于EN。结论全胃切除术后早期肠内营养安全、有效、经济,对促进胃肠道功能恢复,保持肠道黏膜,减少感染性并发症,改善机体营养状况等起到一定的积极作用。

Aim To study the safety and feasibility of clinical effect of early enteral nutrition after total gastrectomy. Methods 90 cases of postoperative patients of stomach carcinoma after total gastrectomy were randomly divided into three groups （ n = 30）, enteral nutrition 24 hours after operation （EN group ）, par-enteral nutrition 8 days after operation （PN group ） and routine supplement group （control group）. The energy was approximately equal among three groups. The nutritional status of patients were measured before and after nutri- tional support, and vital signs and recovery of gastrointestinal function, the complications, hospital stay and hospitalized charge were also evaluated. Results The level of serum total protein,albumin, transferring ferroprotein and weight in the three groups were declined after operation and it was more obvious in the control group（ P 〈 0. 01 ）. The level of pre-albumin was obviously elevated in PN and EN groups （ P 〈 0. 01 ）. The bowel moved obviously earlier in EN group than the other two groups and the rate of morbidity was the lowest after operation. Time in hospital was shortest and the cost was low in EN group. Conclusion The early enteral nutrition after total gastrectomy is effective,safe,economic and better for maintaining the gastroenteric function and nutrition condition of patients.