肠内营养泵在胃癌术后化疗中的应用

Enteral nutrition with jejunal feeding pump during postoperative chemotherapy in patients with gastric cancer

目的 探讨肠内营养泵在胃癌术后化疗期间经空肠造口管实施肠内营养（EN）中的作用.方法 选取经手术切除并术中放置空肠造口管的106例胃癌患者,其中使用肠内营养泵在化疗期间经空肠造口管实施EN者53例（观察组）,使用一般输液器在化疗期间经空肠造口管实施EN者53例（对照组）.经6周期静脉化疗结束后评估两组患者的EN耐受程度、造口管并发症及营养改善程度.结果 观察组完成实验47例,对照组完成实验35例.对照组导管并发症发生率为26.19%,耐受率为100%;观察组并发症发生率为6.12%,耐受率为95.92%;两组患者并发症发生率及耐受率的差异均有统计学意义（P＜0.05或0.01）.化疗结束后观察组体重下降度显著低于对照组（P＜0.01）,观察组第6次化疗结束后预后营养指数（PNI）显著高于对照组（P＜0.01）;与化疗前比较,对照组第6次化疗结束后PNI较化疗前显著降低（P＜0.01）,观察组化疗前后差异无统计学意义（P ＞0.05）.结论 在胃癌术后化疗期间,经空肠造口管合理使用肠内营养泵给予EN,可明显增强EN的耐受程度,减少造口管并发症和改善患者的营养状况.

Objective To evaluate the application of enteral nutrition（EN） with jejunal feeding pump during postoperative chemotherapy in patients with gastric carcinoma. Methods One hundred and six patients with gastric cancer underwent gastrectomy with radical resection and jejunostomy, all patients received postoperative chemotherapy. The patients were randomly assigned to receive EN by jejunal feeding pump（n=53, group A） or by normal infusion tube（n=53, group B）. The EN tolerance, complication of feeding tube and improvement of nutrition status were analyzed and compared between two groups. Results Total 82 patients completed 6 cycles of chemotherapy, 47 in group A and 35 in group B. The rate of complications of feeding tube in group A was lower than that in group B（6.12% vs 26.19%,P〈0.01）. The tolerance of EN in group A was better than that in group B （P〈0.05）. There was weight loss after six cycles of chemotherapy in both groups; while that in group A was less （6.7± 0.97%vs8.2 ± 1.4%,P〈0.01）. After six cycles of chemotherapy, the prognostic nutritional index（PNI） in group B was significantly decreased （P〈0.01）; while that in group A was not significantly changed （P 〉0.05）, and the latter was much higher than the former （P〈0.01）. Conclusion Enteral nutrition with jejuna feeding pump during chemotherapy after gastrectomy for gastric carcinoma can enhance the tolerance of EN, reduce the complication of feeding tube and improve the nutrition status of patients.