食管癌术后早期肠内营养支持的疗效研究

Efficiency of early enteral nutrition after esophagectomy： a prospective, randomized and controlled clinical trial

目的观察早期肠内营养支持改善食管癌术后患者营养状态的作用及评价早期肠内营养的安全性、有效性。方法选择食管癌术后进行营养支持的患者120例，根据所采用的营养方式不同分成研究组（64例）给予肠内营养、对照组（56例）经深静脉导管给予胃肠外营养，2组营养支持均等热量和等氮量。分别于术后第1天及第8天检测营养指标，测定每日氮平衡和计算累计氮平衡，术后第1、4、8天检测肠黏膜屏障指标：血浆内毒素水平、D-乳酸水平及二胺氧化酶水平。观察术后感染率和营养支持并发症的发生率。结果①研究组在术后第8天白蛋白、前白蛋白水平明显高于对照组，血糖水平、1-谷氨酰转肽酶、碱性磷酸酶、总胆红素、直接胆红素水平明显低于对照组（P〈0．05）。②术后第3天起研究组每日氮平衡和累计氮平衡均优于对照组。③术后第8天研究组内毒素、D-乳酸及二胺氧化酶水平明显低于对照组（P〈0．01）。④与对照组相比，研究组血液、肺部、肠道等处感染率低（P〈0．05）。⑤研究组营养支持无严重并发症发生，研究组肛门排气时间明显早于对照组[（42±11）h比（74±21）h，P〈0．05]，营养支持费用明显少于对照组[（6690±830）元比（12340±1120）元，P〈0．051。结论食管癌术后早期肠内营养是安全可行的。早期肠内营养更能有效地改善术后患者的营养状态，维护肠黏膜屏障功能，减少术后感染并发症的发生，降低住院费用，具有明显的优越性。

Objective To evaluate efficiency and security of early enteral nutrition in patients after esophagectomy. Methods A randomized controlled clinical trial was conducted regarding the role of early enteral nutrition（EN） with parenteral nutrition（PN） in 120 patients after esophagectomy. The intake was isonitrogenic and isocalorie in the two groups. Nutrition state test before operation, lth and 8th day after operation was analyzed. Nitrogen balance was measured daily. Plasma concentrations of D （-）-lactate, diamine oxidase （DAO） and endotoxin were determined on the lth, 4th and 8th days after operation. Infection rate and complication rate of nutrtion support after operation were observed. Results （1） The concentration of serum albumin and prealbumin in the group of EN was higher than that in the PN group and the concentration of blood glucose,＇,/-GT, AKP, TB, DB was lower than that in the PN group（P 〈0.05）. （2） Nitrogen balance was superior in EN group than those in the PN group. （3） The concentrations of D （-）-lactate, DAO and endotoxin of the EN group were significantly lower than those of the PN group on the eighth day after operation（P 〈0.01 ）. （4） The infectious rates of blood, lung, gut tract in EN group were lower than those in the PN group（P 〈 0. 05）. （5） There was no severe complications of nutrition supply in EN group, The time of passage of gas by anus of EN group was shorter and the cost of nutrition was less than that in the PN group （P 〈 0. 05）. Conclusions （2） EN is safe and feasible after esophagectomy. （2） Campared with PN support, EN support can more efficiently ameliorate the nutrition state of the patients receiving esophagectomy. （3） EN plays an important role in recovery of gut barrier function after esophagectomy. （4） EN support can reduce the rate of postoperative infection and decrease the cost in hospital.