术中留置鼻空肠营养管效果观察

Observation on effect of intraoperative indwelling nasointestinal feeding tube

目的探讨胃切除术后早期肠内营养的可行性。方法将择期行胃切除术患者89例分为2组:早期肠内营养组(EEN组)68例和肠外营养组(PN组)21例,均在术后第1天开始运用鼻空肠营养管至术后第8天,观察2组术后恢复肛门排气排便时间、住院时间、营养费用、并发症,监测手术前后体质量、血浆总蛋白、血浆白蛋白、肝功能及其他生化代谢监测指标(尿素氮、肌酐、电解质)。结果术后肠功能恢复时间EEN组小于PN组(P<0.05),住院时间2组比较无显著差异(P均>0.05),营养费用EEN少于PN组(P<0.05);2组体质量、血浆总蛋白和血浆白蛋白治疗后均下降(P均<0.05),但组间比较无显著性差异(P均>0.05),谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(AKP)治疗后2组均无显著改变。乳酸脱氢酶(LDH)治疗后PN组高于EEN组(P<0.05)。总胆红素(TBil)2组治疗后无显著改变。结论术中留置鼻空肠营养管对胃切除术后早期肠内营养能促进肠功能恢复,提供有效的营养支持,并且费用低廉,值得推广。

Objective It is to approach the application of early enteral nutrition through nasointestinal feeding tube after gastrectomy. Methods 82 patients after selective gastrectomy were randomly divided into early enteral nutrition （EEN） group with 68 cases and parenteral nutrition （PN） group with 21 cases. The nutrition support was used from the first day to the seventh day after operation. In both groups; the time of passage of gas by anus and defaecation, the time of hospitalization, the cost of nutrition, complication, weight before and after operation, total protein, albumin, liver function and other biochemistry metabolism monitor target （urea nitrogen, creatinine, electrolyte） were observed and recorded. Results The time of intestine functional recovery in EEN group was less than that in PN group （P 〈 0.05）. There was no significant difference in the time of hospitalization between two groups （ P 〉 0.05）. The cost of nutrition in EEN group was less than that in PN group （P 〈 0.05）. All patients＇ body weight, total protein and albumin were descended after operation （P 〈 0.05）, but there was no difference between two groups （P 〉0.05）. The levels of alanine transarninase （ALT）, the glutamic-oxal（o） acetic transamlnase （AST）, the alkaline phosphatase （AKP） did not change. The level of actic dehydrogenase （LDH） in PN group is higher than that in EEN group （P 〈 0.05）. The total bilirubin （TBil） in both groups did not remarkable changes. Conclusion EEN through intraoperative indwelling nasointestinal feeding tube in gastrectomy can speed the intestine functional recovery, offer effective nutrition support, and cost more cheaply.