肠内与肠外营养在老年食管癌病人围手术期应用的比较

A prospective randomized controlled clinical study of perioperative enteral or parenteral nutrition support for elderly patients with esophageal caricinoma

目的:客观评估围手术期肠内营养(EN)与肠外营养(PN)支持对老年食管癌病人术后转归的影响。方法:采用单中心前瞻性随机对照临床研究设计,将老年食管癌病人随机分为EN组(研究组,26例)和全肠外营养组(TPN)(对照组,27例)。研究组病人于术前5 d开始,除正常饮食外,再加口服EN液(康全甘)500 ml/d,术后24 h开始输注EN液;对照组病人术后常规使用TPN。并于术前5 d、手术当天、术后24 h和术后1周分别检测两组病人肝功能、三酰甘油和空腹血糖,记录术后30 d内并发症发生率及种类、住院天数、术后重症监护室留观天数,医疗费用和病死率。结果:研究组病人术后第1天清蛋白和前清蛋白水平显著高于对照组。对照组病人术后第7天转氨酶、三酰甘油和空腹血糖显著升高。对照组病人Ⅲa级以上严重并发症发生率显著增高。研究组病人住院天数、重症监护室留观时间和医疗费用均显著低于对照组。结论:老年食管癌病人围手术期应用EN支持可改善糖脂代谢,降低术后严重并发症率,减少医疗费用。

Objective： To evaluate the clinical value of perioperative enteral nutrition support in elderly patients with esophageal carcinoma. Methods： A single center prospective randomized controlled clinical study was designed, and elderly patients with esophageal carcinoma were randomly divided into perioperative enteral nutrition group （study group 26 cases） and routinely postoperative total parenteral nutrition group （control group 27 cases）. Study group patients on preoperative day 5 began normal diet plus oral Nutrison TP-MCT 500 ml per day, and started intrajejunal infusion of Nutrison TPF24 hours after operation. Control group used postoperative intravenous ＂All-in-One＂ total parenteral nutrition routinely. ALT, AST, albumin, prealbumin, triglycerides and fasting glucose were examined. Mortality within 30 days after operation, complication and types,length of hospital stay, postoperative ICU stay and medical cost were also recorded. Results： In the first day after surgery, study group showed significantly higher albumin and prealbumin levels than those in control group. In the seventh days after operation, no significant differences of albumin and prealbumin levels were recorded, while in the control groupALT,AST, triglyceride and fasting blood glucose were significantly increased. Mortality and morbidity rates were not significant different between two groups, but the control group contained more serious complications. The length of hospital stay, ICU stay, medical costs were synchronized significantly lower in the study group. Conclusion： Elderly patients with esophageal carcinoma might benefit from perioperative enteral nutrition support by improving glucose and lipid metabolism, reducing the serious postoperative complications ,and saving medical costs.