术前肠内强化营养在食管癌手术治疗中的应用研究

Application Study of Preoperative Fortified Enterai Nutrition in the Operation Treatment of Cancer of the Esophagus

目的观察术前肠内强化营养对食管癌患者手术治疗的影响。方法将2006年1月。2009年lO月胸段食管癌患者120例随机分为研究组和对照组，每组60例。两组均维持入院前饮食质量，研究组于术前5d开始经口肠内营养乳剂“瑞高”500m1强化营养治疗。术后均行同质量肠外营养支持和早期肠内营养支持。观察术前体重变化，术前5d、术前1d、术后第2天、术后第8天检测外周静脉血血红蛋白、血清白蛋白、淋巴细胞计数。记录术中静脉复合全麻实施前后中心静脉压、术中静脉补液量，记录术后胸腔引流量、引流时间，肠蠕动恢复时间，术后肠内营养不适发生率。结果术后肠内强化营养组血清白蛋白、术后第8天淋巴细胞计数高于对照组；全麻前后中心静脉压下降、术中补液量、术后胸腔引流量、闭式引流时间、肠蠕动恢复时间、术后早期肠内营养不适发生率均低于对照组，两纽间差异有显著性（P〈0．05）。术前所测体重、血清白蛋白，术前及术后第2天所测淋巴细胞计数及术前术后所测血红蛋白，两组间差异无显著性（P〉0．05）。结论术前短期肠内强化营养治疗可以增加手术的安全性，有利手术恢复，减少并发症发生风险，对术后早期肠内营养的实施有辅助作用，对顺利完成食管癌围手术期治疗有显著效果。

Objective To evaluate the efficts of preoperative fortified enteral nutrition on the operation treatment of cancer of the esopbagus. Methods One hundred and twenty patients with thoracie segment cancer of the esophagus between January 2006 and October 2009 were randomly divided into the fortified enteral nutrition group（60 eases） and the control group（60 cases）. Maintaining prehospital quality of the diet and accepting same quality postoperative parenteral nutrition support and early enteral nutrition support in both groups,the patient of study Group took 500ml Fresubin MCT 750 eaeh day from 5th day before the operation as preoperative fortified enteral nutrition. The preoperative change of body weight was observed. Hemoglobin, serum albumin ,lymphocyte eount of peripberal venous blood was deteeted respeetively in 5d, 1 d befi）re operation and 2d,8（t after operation. Intraoperative central venous pressure around intravenous combined anesthe- sia and volume of intravenous fluids,volume and time of postoperative closed drainage of pleural cavity,enteroeinesia recovery time and incidence rate of diseomlbrt because of postoperative enter nutrition were reeorded. Results Serum a｜bumin and lymphocyte counl in postoperative 8th clay in the fortified enteral nutrition group is higher than control group,and the Intraoperative central venons pressure decreasing around intravenous combined anesthesia, volume of intravenous fluids,volume and time of posloperative closed drainage of pleural cavity, entroeinesia recovery time and incidence rate of discomfort because of postoperative enteral nutrition is Jess than control group. There are signifi- cant difference between two group（ P 〈0.05）. But concerning the preoperative change of body weight and sel＇nm albumin,lympiloeyle count detected in preoperation and postoperative 2nd clay aml hemoglobin, there are no significant difference between two group （ P 〈 0.05 ）. Conclusion Preoperative fortified enteral nutrition was effective in perioperative surgieal treatment of cancer of the esophagus by increasing operative safety, making for postopertive recovery, reducing risk of complications and auxiliary function for postoperative earl）, stage entera] nutrition.