胃癌术后早期肠内营养治疗对患者营养恢复的影响

Impact of early postoperative enteral nutrition therapy on gastric cancer patients

目的观察早期肠内营养对胃癌术后患者术后恢复和营养指标的影响。方法选择2007年1月至2011年12月于上海市第一人民医院宝山分院行胃癌根治术的患者86例,随机分为早期肠内营养组(EEN组)和肠外营养组(PN组),每组43例。观察两组手术前后的血清白蛋白(ALB)、转铁蛋白(TF)、前白蛋白(PA)、视黄醇结合蛋白(RBP)、体质量(BW)、肱三头肌皮肤皱褶(TSF)和疲劳指数(Christensen's评分),以及术后肛门排气时间、住院时间、Karnofsky评分和并发症发生率。结果两组术后第7天的BW、TSF、ALB、TF、PA和RBP均较术前第1天出现明显降低(P<0.01),而PN组的TF、PA和RBP水平较EEN组降低更为明显(P<0.01),两组的BW、TSF和ALB水平差异无统计学意义(P>0.05)。而术后第7天的Christensen's评分较术前第1天出现明显提高,而PN组的升高较EEN组更为明显,差异有统计学意义(P<0.01)。EEN组的肛门排气时间、住院时间和Karnofsky评分均较PN组明显缩短或者降低(P<0.01),而两组并发症比较差异无统计学意义(P>0.05)。结论早期肠内营养有助于胃癌术后患者的早期康复,改善患者营养状况,促进胃肠道功能恢复,缩短住院时间。

Objective To evaluate the postoperative recovery and nutrition indicators in gastric cancer patients after early enteral nutrition. Methods 86 patients with gastric cancer after radical surgery, from January 2007 to December 2011, were randomly divided into early enteral nutrition （EEN group） and parenteral nutrition （PN）. Serum albumin （ALB）, transferrin（TF）, prealbumin （PA）, retinol binding protein （RBP）, body weight （BW）, triceps skin fold （TSF） and fatigue index （Christensen＇s score） were determined before and after surgery. The postoperative flatus, duration of hospitalization, Karnofsky score, and complication rate were also determined. Results At day-7 after the surgery, the values of BW, TSF, ALB, TF, PA and RBP were significantly reduced （P〈0.01）. The levels of TF, PA and RBP in the PN group were significantly lower than those in the EEN group （P〈0.01）. There were no significant difference in the values of BW, TSF and ALB between the two groups （P〉0.05）. The Christensen＇s score was significantly increased at day-7 after operation, and the increase was more apparent in the PN group（P〈0.01）. In the EEN group, the time of flatus, length of stay, and Karnofsky scores were significantly reduced when compared with the PN group （P〈0.01）. However, the complications were not significantly different between the two groups（P〉0.05）. Conclusion Early enteral nutrition therapy contribute to the early rehabilitation in postoperative patients with gastric cancer, improvement of the patients nutritional status, promoting the recovery of gastrointestinal function, and shortening of the hospital stay.