全肠外营养及早期肠内营养在胃癌全胃切除术后患者中的对比研究

Comparative Study of Total Parenteral Nutrition and Early Enteral Nutrition in Patients with Gastric Cancer after Total Gastrectomy

目的探讨胃癌全胃切除术后的患者分别进行早期肠内营养(EEN)或全肠外营养(TPN)支持对患者术后恢复的影响。方法回顾性分析我院2006年6月至2009年8月期间行全胃切除的患者86例,其中术后行TPN者31例(TPN组),行EEN者55例(EEN组)。TPN组通过上腔静脉(颈内或锁骨下)穿刺置管,经静脉给予营养支持;EEN组术中留置鼻肠管,术后第2天开始逐渐增加肠内营养(瑞素),并逐步减少肠外营养,至术后3～5d达到全肠内营养。检测术后血清白蛋白水平,记录术后通气与排便时间、经口进食时间、住院时间以及各种并发症的发生情况。结果TPN组与EEN组比较,术后血浆白蛋白、术后通气时间、排便时间、并发症发生率及住院时间差异均无统计学意义(P>0.05)。在进流质时间上EEN组反而晚于TPN组,差异有统计学意义(P=0.004)。结论经TPN进行营养支持与鼻肠管进行肠内营养均可作为全胃切除术后的营养支持方式,两种方式的恢复情况及并发症发生情况无明显差异,可以根据患者术前营养状态及合并症决定是否行鼻肠管置入。

Objective To investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition （EEN） to patients with gastric cancer after total gastrectomy.Methods Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group （n=31） and EEN group （n=55）.Patients in TPN group received TPN support via vena cava （internal jugular vein or subclavian vein）,while patients in EEN group received early feeding through the naso-intestinal tube,which was placed during operation,and volume of enteral nutrition （fresubin） was increased daily,full enteral nutrition was expected on day 3-5.Nutrition status after operation,postoperative plasma albumin （Alb）,the time of passing gas or stool,the time of oral intake,hospital stay and any postoperative complications were recorded and analyzed.Results There were no significant differences between two groups （P〈0.05） in postoperative plasma Alb level,the time of passing gas or stool,postoperative complications rate or hospital stay.However,in the TPN group,the time of oral intake was shorter than that in EEN group （P=0.004）.Conclusions Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy,and with no detectable difference.For patients with high risk,such as severe malnutrition,naso-intestinal tube should be placed for EEN.