食管癌术后短期内行不同营养支持方法的临床效果与满意度研究

Clinical efficacy and satisfaction of different nutritional support methods employed on short-term postoperative esophageal carcinoma patientscomparative study

目的观察并对比食管癌患者术后7d内行鼻肠管肠内营养（enteralnutrition，EN）与肠外营养（parenteralnutrition。PN）的临床效果及患者满意度。方法将我院肿瘤外科2009年10月～2012年2月人选的92例食管癌手术患者随机单盲分为A、B两组，A组（48例）患者术后生命体征平稳后予鼻肠管EN支持，B组（44例）患者予PN支持，对比两组患者术前1d与术后7d营养学指标、肠功能恢复情况及期间的并发症，7d后对患者进行营养支持方法的满意度调查。结果①两组患者术后血清白蛋白（ALB）、血清总蛋白（TP）及总胆红素（TBil）均较之手术前下降（P〈0．05），术后7dB组患者以上理化指标高于A组，差异无统计学意义（P〉0．05）；②A组患者肛门排气时间[（2．3±0．4）d]与住院时间[（16．3±3．2）d]均少于B组[（2．8±0．6）d，（17．5±4．3）d]，其中，肛门排气时间差别具有统计学意义（P〈0．05）；③A组腹泻并发症例数高于B组，B组腹胀、切口感染例数高于A组，以上差别均无统计学意义（P〉0．05）；A组发生特发性反流误吸5例（10．4％），B组静脉置管处发生静脉炎2例（4．6％）；④B组患者舒适性得分优于A组，但经济性以A组为佳（P〈0．05）。结论①食管癌患者术后早期短时间内行鼻肠管EN与PN营养支持达到的临床效果与安全性相仿；②EN与PN各有优缺点，前者的主要优点集中胃肠功能的早期恢复与经济性，PN的主要优点在于胃肠道反应较少，患者舒适性较高。

Objective To have a comparative study on clinical effect and patients＇ satisfaction of nutritional support methods between entera] nutrition （EN） via nasal tube and parenteral nutrition （PN） via venous catheter on early post- operative esophageal carcinoma patients. Methods 92 admitted cases of oncological surgery department were single blindly randomized into A and B group, group A （48 cases） was received EN support after vital signs stabilized, corre- spondingly, group B （44 cases） was received PN support, and comparative study was conducted between 2 groups on observational indexes of nutrition, recovery of intestinal function and complications on time points of the day before operation and 7 days after operation, besides, patients＇ satisfaction on nutritional support method was also interviewed. Results ①Patients of two groups whose serum albumin （ALB）, serum total protein （TP） and. total bilirubin （TBiI） were obviously decreased compared with preoperation （P 〈 0.05）, and physiochemical nutritional indexes 7 d after operation of group B was higher than that of group A, the difference was not significant （P 〉 0.05）; ②Patients of group A whose anal exhaust time [（2.3±0.4） d] and hospitalization time [（16.3±3.2） d] were both lower than that of group B [（2.8±0.6） d and （17.5±4.3） d], the difference of anal exhaust time had statistics significance （P 〈 0.05）; ③Cases of group A with bloating, diarrhea complications were higher than that in group B, infectious cases of incision were higher than that in group A, these differences said before were not statistically significant （P〉 0.05）; There were 5 cases （10.4%） occurred idiopathic reflux and aspiration in group A, and 2 cases （4.6%） occurred catheter phlebitis in group B; ④Patients of group B whose comfort score was higher than that of group A, but economic score of group A was priors to group B. Conclusion ①EN and PN nutritional support methods to early postoperative patients with esophageal eanee can reach similar clinical effect and medical safety within short time period;②EN and PN both have advantages and disadvan- tages, the former whose main advantages focuses on gastrointestinal function in early recovery and economy, while main advantages of the latter are its less gastrointestinal reaction and comfort.