老年胃癌术后早期肠内、外营养的联合应用

The Application of Early Postoperative Enteral Nutrition Combinded with Parenteralnutriton in Aged Patients with Gastric Carcinoma

目的探讨老年胃癌术后早期肠内营养和肠外营养联合应用的临床价值。方法将153例老年胃癌手术患者随机分为3组:(1)肠外营养组(PN组,n=50),给予静脉营养;(2)肠内营养组(EN组,n=51),早期鼻肠管要素饮食;(3)肠内营养和肠外营养联合组(CEP,n=52),自配制营养液,简易鼻肠管注入,配合静脉营养,相互补充。观察在治疗过程中3组患者并发症的发生率、术后胃肠功能恢复时间、术后住院时间、住院费用及营养评定的各项指标,并进行对比分析。结果EN组和CEP组各项观察指标比较,均无统计学意义(P>0.05);PN组术后肛门排气时间及住院时间较CEP组和EN组明显延长(P<0.05),住院费用较EN组和CEP组高(P<0.05);3组患者术后并发症、血清白蛋白、前白蛋白、转铁蛋白和体质量的变化无明显差异(P>0.05)。结论老年胃癌术后早期肠内营养及肠外营养联合应用安全可行。在改善机体营养状况方面与肠外营养和肠内营养相似,但费用较低、住院时间短。

Objective evaluate the clinical effect of enteral nutrition（EN） combined with parenteral nutrition（PN）in aged patients with gastric carcinoma. Methods 153 aged patients of gastric carcinoma undergone gastrectomy were randomly divided into three groups： （1）in PN group（n= 50） ,all patients were treated with total parenteral nutrition. （2）in EN group（n=51）,all patients received total enteral nutrition. （3）in conbination of EN and PN（CEP） group（n= 52） ,all patients were given enteral nutrition combined with parenteral nutrition. Complications,passage of flatus, length of postoperative stay,cost and nutritional evaluation were analyzed. Results By the univariate and multivariate analysing, there are no significant difference between EN group and CEP group（P〉0.05）. The time of passage of flatus and the postoperative stay of PE group was longer than that of the other two groups（P〈0. 05）,while the cost of PE group was more than the other two groups（P〈0.05）. And among the three groups,no significant differences were indicated about the postoperative variation of complication, albumin, proalbumin, transferrin and weight （P〉0. 05）. Conclusion In aged patients with gastric malignant tumor, early enteral nutrition combined parenteral nutrition is safe and feasible. It has the function like TPN in improve nutritional status. And it cost less, has shorter postoperative stay and is easy and convenient in clinical application.