胃癌术后经鼻肠管早期肠内营养支持79例临床护理

Clinical nursing care of 79 patients with early enteral nutrition support via nasointestinal tube after gastrectomy for gastric cancer

目的:探讨胃癌术后经鼻肠管早期肠内营养支持患者的护理方法。方法:对79例进展期胃癌患者术后24h经鼻肠管和肠内营养输注泵匀速输入能全力,观察胃肠道功能恢复情况、输液速度、肠道耐受情况、各种不良反应和并发症,并分别在营养支持前后检测CD3、CD4、CD8、CD4/CD8细胞免疫指标,术前、术后第2天、第8天测体重并检测肝肾功能、血浆蛋白、白蛋白、血糖、电解质和血常规。结果:所有患者肠内营养支持过程中生命体征平稳,术后肛门排气时间为(48±6.4)h,无术后并发症发生。7例因输注速度过快出现恶心、腹胀、腹痛、腹泻,减漫速度后症状缓解。肝肾功能、血糖、电解质测定在肠内营养支持过程中均正常。体重、血浆蛋白、白蛋白、血红蛋白测定术后较术前均有下降,但术后第8天较术后第2天有不同程度上升(P<0.05)。CD3、CD4、CD4/CD8在术后第8天较术前增加(P<0.05,P<0.01)。结论:胃癌切除术后早期肠内营养支持能促进胃肠道功能恢复,有改善和恢复机体营养状况及细胞免疫功能的作用,合理的监护能使营养计划顺利完成,值得临床推广应用。

Objective： To explore the nursing methods for the patients with early enteral nutrition support via nasointestinal tube after gastrectomy for gastric cancer. Methods ： 79 patients with advanced gastric cancer were given enteral nutrition of Nutrison fibre by infusion pump via nasointestinal tube 24 hours after operation. The recovery of gastrointestinal function, infusion rate, intestinal tolerance, various adverse reactions and complications were fully observed, and cell - mediated immunity indexes of CD3, CD4, CD8, CD4/CD8 were respectively detected before and after nutritional support; body weight, liver and kidney function, plasma protein, albumin, blood glucose, electrolytes and blood routine were measured and tested on the 2nd and 8th day after operation. Results ： The vital signs of all patients were stable in the duration of enteral nutrition support. The postoperative anal exhaust time was 48 ± 6.4 hours and no postoperative complications occurred. Nausea, abdominal distension, abdominal pain and diarrhea occurred in 7 patients due to high infusion rate and the symptoms were alleviated when the infusion rate was slowed. Liver and kidney function, blood sugar, electrolytes were normal in the course of enteral nutrition support. Body weight, plasma protein, albumin, hemoglobin decreased compared with that before surgery, but the items increased on the 8th day compared with＇that on the 2nd day after surgery （ P 〈 0. 05 ）. CD3, CD4, CD4/CD8 increased on 8th day after surgery （ P 〈 0. 05, P 〈0. 01 ） Conclusions： Early enteral nutrition support can promote the resumption of gastrointestinal function and improve the nutritional status and cellular immune function of the patients. Reasonable nursing care will enable patients to complete nutrition program. It is worthy to be popularized.