胃癌围手术期营养支持的临床研究

Clinical research of nutrition maintenance for gastric cancer during perioperative period

目的：研究胃癌病人围手术期营养支持的临床疗效以及肠内、肠外营养方式的优缺点。方法：将３４例胃癌病人随机分为肠内营养（ｅｎｔｅｒａｌｎｕｔｒｉｔｉｏｎ，ＥＮ组）和肠外营养（ｐａｒｅｎｔｅｒａｌｎｕｔｒｉｔｉｏｎ，ＰＮ组）两组，每组１７例。围手术期给予等热量等氮量的营养支持，术前进行７～１０天的营养支持，术后３～１０天经不同途径进行营养支持。结果：术后１０天两组血清转铁蛋白（ＴＦ）、前白蛋白（ｐｒｅａｌｂ）、纤维连接蛋白（ＦＮ）水平均显著提高（Ｐ＜０．０５或Ｐ＜０．０１），术后１０天ＰＮ组Ｐｒｅａｌｂ、ＦＮ水平显著高于ＥＮ组（Ｐ＜０．０１）；而ＥＮ组肠功能恢复早于ＰＮ组，住院时间和营养费用少于ＰＮ组。结论：伴有严重营养不良的胃癌患者，围手术期营养支持能改善病人营养状况，ＰＮ优于ＥＮ，而ＥＮ有利于肠功能恢复。

Objectives:To study the nutrition maintenance for gastric cancer during perioperative period. Methods:Thirty four cases of gastric cancer patients were randomly devided into enteral nutrition(EN) group and parenteral nutrition(PN) group.Each group had 17 cases.Nutrition maintenance was given with isocalorie and isonitrogen during the perioperative period.7￣10 days of nutrition maintenance was given before operation,and 3￣10 days of nutrition maintenance was given through different channels after operation. Results:Two groups of serum transferritin(TF),prealbumin(Prealb) and fibronection(FN) increased remarkably 10 days after operation ( P <0.05 or P <0.01).Prelb and FN in PN group( P <0.01) was remarkably higher than that in EN group recovered earlier than that in PN group,and hospitalization time and nutrition expenses of EN group was less than that of PN group. Conclusions:Nutrition maintenance during perioperative period can improve nutrition situation of the organism for the gastric cancer patient with malnutrition.With regard to curative effect,PN group is better than EN group,but EN group is benefical to intestinal function recovery,as well as reduces nutrition expenses and hospitalization time.