胃癌全胃切除术后早期肠内营养的临床研究

Clinical Study on Early Enteral Nutrition in gastric Cancer Patients after Total Gastrectomy

目的:探讨胃癌全胃切除术后早期肠内营养(EN)和全肠外营养(PN)对术后营养状况和免疫功能等状况恢复的影响。方法:50例胃癌全胃切除术后患者随机分为EN组和PN组,每组各25例。EN组术中放置空肠造口管,术后24h以内管喂肠内营养液肠内高营养多聚合剂(能全力),PN组给予等氮、等热量的标准PN,总热量为125kJ(/kg·d)术前1d、术后第1、10d观察并比较两组病人手术前、后的营养和免疫指标、术后肠鸣音恢复、肛门排气时间和并发症发生的情况。结果:所有病例无手术死亡、无严重并发症发生;两组病人术后营养支持的营养及免疫指标明显改善(P<0.05),EN组前白蛋白和免疫指标较PN组明显提高(P<0.05);EN组较PN组术后胃肠功能恢复的更早,并发症的发生率亦明显减低,同时住院时间短。结论:胃癌全胃切除术后早期予肠内营养安全、有效,既能促进胃肠道功能早期恢复,又可改善患者术后营养状况和免疫功能,是值得推广的营养支持方式。

Objective： To investigate the effects of early enteral nutrition （EN） and total parenteral nutrition （PN） on the nutritive status, immunologic function and recovery in postoperative patients with gastric cancer. Methods： Fifty patients with gastric cancer and total gastrectomy were prospectively randomized into EN and PN group, each with 25 cases. The patients in EN group were received jejunostoma tube infusion with nutrison from the first day after operation, and those in PN group received isocaloric and isonitrogenous nutritional formulas with the nutritional goal 125 kJ/ （kg. d） at the same day with EN group. And the nutrition state, immune parameters, recovery of bowel movement and complications were observed in both groups at the first and the tenth day after operation. Results： Neither mortality nor serious morbidity occurred in any patients during the period of study. Nutritional status and immune parameters have been improved after nutritional treatment in two groups （P〈0.05）.The improvement ofprealbumin and immune parameters in EN groups were better than those in PN group （P〈0.05）. The recovery of intestinal function was better in EN groups. The rate of complication in EN group was lower than that in PN group （P〈0.05）. Conclusions： EN via jejunostoma tube infusion is safe and effective in patients after total gastrectomy, and early EN support can promote recovery of intestinal movement and improve nutritional status and immunological function in postoperative patients with gastric cancer.