肠内及肠外营养在根治性远端胃大部切除术后胃瘫治疗中的作用

Effect of enteral nutrition vs parenteral nutrition in management of gastroparesis after radical subtotal gastrectomy

目的:比较肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)在根治性远端胃大部切除术后胃瘫治疗中的作用,探究术后胃瘫治疗中的适当营养方式.方法:52例根治性胃大部切除术后胃瘫患者,按术后营养治疗方式分为EN组(n=36)和PN组(n=16),分别给予EN或PN治疗.比较两组平均胃排空功能恢复时间和血红蛋白、总蛋白、白蛋白的差异.结果:EN组平均胃排空功能恢复时间低于PN组,组间比较差异无显著性(25.3d vs28.2d,P>0.05).治愈后EN组血红蛋白、总蛋白、白蛋白水平与PN组比较差异无显著性(均P>0.05).E N组患者营养支持费用明显低于PN组(398.74元/d±47.68元/d vs512.77元/d±54.31元/d,P<0.05).与治疗前比较,EN组治疗后的血红蛋白、总蛋白、白蛋白均明显升高,差异均有统计学意义(123.25g/L±15.68g/Lvs117.25g/L±13.28g/L;70.34g/L±12.85g/Lvs65.13g/L±10.76g/L;40.65g/L±8.15g/Lvs36.20g/L±9.16g/L,均P<0.05);PN组治疗后血红蛋白(125.14g/L±13.39g/Lvs120.32g/L±14.67g/L)和总蛋白变化较大(67.52g/L±13.09g/Lvs64.23g/L±12.47g/L,P<0.05),而白蛋白仅略升高(P>0.05).治疗前后EN组血红蛋白、总蛋白及白蛋白的变化幅度均明显高于PN组各项指标,且差异均有统计学意义(P<0.05).结论:EN对术后胃瘫的全身支持及减少并发症的发生有着积极的治疗作用,是术后胃瘫的营养治疗中的安全有效措施.

AIM： To compare the effect of enteral nutrition （EN） and parenteral nutrition （PN） in manage- ment of gastroparesis after radical subtotal gastrectomy to find out the proper way for the therapy of gastroparesis. METHODS： Fifty-two patients with gastroparesis after radical subtotal gastrectomy were divided into an EN group （n = 36） and a PN group （n = 16）, which received EN and PN, respectively. The differences in the time required for recovery of gastric emptying and the levels of hemoglobin, total protein and albumin after recovery from gastroparesis were compared between the two groups. RESULTS： The average time required for recovery of gastric emptying was lower in the EN group than in PN group, but there was no sig- nificant difference between the two groups （25.3 d vs 28.2 d, P 〉 0. 05）. There were no significant differences between the two groups in the levels of hemoglobin, total protein or albumin after recovery from gastroparesis （all P 〉 0.05）. The treatment expense （RMB/d） was significantly lower in the EN group than in the PN group （398.74 ± 47.68 vs 512.77 ± 54.31, P 〈 0.05）. After treatment, the levels of hemoglobin, total protein and albumin were significantly raised in the EN group （123.25 ± 15.68 vs 117.25 ± 13.28; 70.34 ± 12.85 vs 65.13 ± 10.76; 40.65 ± 8.15 vs 36.20 ± 9.16, all P 〈 0.05）, and only the levels of hemoglobin and total protein were significantly raised in the PN group （125.14 g/L ± 13.39 g/L vs 120.32 g/L ± 14.67 g/L; 67.52 g/L ± 13.09 g/L vs 64.23 g/L ± 12.47 g/L, both P 〈 0.05）. The changes in the levels of hemoglobin, total protein and albumin between before and after treatment were more significant in the EN group than in the PN group （all P 〈 0.05）. CONCLUSION： EN has a positive therapy effect on systemic support, can reduce the occurrence of complications and is therefore a safe and effective nutrition therapy in patients with gastro- paresis after radical subtotal gastrectomy.