胃肠道肿瘤术后肠外营养支持起始时间的临床研究

Clinical study on the timing of postoperative parenteral nutrition support in patients of gastrointestinal neoplasms

目的探讨存在营养风险的胃肠道肿瘤患者手术后进行肠外营养支持的合适起始时间。方法采用随机对照临床研究，符合研究标准的胃肠道肿瘤患者80例，分为研究组（40例）和对照组（40例）。研究组术后第2天进行肠外营养支持，对照组术后第1天进行肠外营养支持。比较两组患者术后营养指标的变化、胃肠道功能恢复时间、感染并发症、全身炎症反应综合征、术后营养支持相关费用及术后住院时间。结果2组患者在年龄、性别、体质指数、疾病和手术类型等方面具有可比性。与对照组比较，研究组术后肛门排气时间提早[（3．33±1．10）dVS．（4．03±1．51）d，P=0．020]，全身炎症反应综合征发生率低（8／40VS．17／40，P=0．030），术后住院时间短[（3．33±1．10）dVS．（4．03±1．51）d，P=0．020]和营养支持费用少[（2144．49±1210．96）元VS．（2915．99±1615．68）元，P=0．018]。实验组与对照组术后营养指标和肠蠕动恢复时间以及感染性并发症发生率无明显差异（P〉0．05）。结论胃肠道恶性肿瘤手术后第2天（24—48h）开始肠外营养支持，有助于促进和加快术后胃肠道功能的恢复，能够更好的节约医疗成本。

Objective To evaluate the timing of postoperative parenteral nutrition support for gastrointestinal tumor patients with a definite nutritional risk. Methods Using a randomized control clinical research methods, 80 gastrointestinal cancer patients were randomly divided into study group （40 cases） and control group （40 cases）. In the study group parenteral nutrition support started on postoperative day 2, while in the control group it started on postoperative day 1. Flatus passing, the rate of infectious complications, the rate of systemic inflammatory response syndrome, postoperative nutrition support related expenses, and the duration of postoperative hospital stay were recorded. Results There was no significant differences between the two groups （ P 〉 0.05 ） in age, sex, body mass index, use of glutamine, disease and type of surgery. Compared with the control group, patients in the study group had earlier postoperative flatus passing [（3.33± 1.10） d vs. （4.03 ± 1.51） d,P = 0.020], less systemic inflammation response syndrome （8/40 vs. 17/40, P = 0. 030 ）, shorter postoperative hospital stay [ （3.33 ±1.10） d vs. （4.03 ± 1.51 ） d, P = 0.020] and lower nutrition support costs [ （2144.49 ± 1210. 96） RMB vs. （2915.99 ± 1615.68） RMB, P = 0. 018 ]. There was no significant difference in postoperative nutrition index, peristalsis recovery time and infectious complications between the two groups （ all P 〉 0.05 ）. Conclusions In patients undergoing surgery for GI tumors, parenteral nutrition support started on post-op day 2 promotes the recovery of gastrointestinal function, while decreasing medical cost.