食管癌术后早期肠内营养预防肺部感染的临床观察

Clinical observation of early enteral nutrition in prevention of pulmonary infections after esophageal cancer surgery

目的探讨食管癌术后早期肠内营养对于肺部感染临床预防效果,为临床工作提供帮助。方法选取医院2011年5月-2012年5月行食管癌手术切除患者50例,采用随机数字表法分为肠外营养组和肠内营养组,每组各25例,分别术后给予全静脉肠外营养支持和鼻肠管滴注肠内营养支持;比较两组患者肺部感染发生率、治疗前后血清白蛋白、血红蛋白、丙氨酸转氨酶、天冬氨酸转氨酶水平、术后排气时间、体重下降等。结果肠外营养组患者肺部感染发生率为32.0%,明显高于肠内营养组患者肺部感染发生率的12.0%,组间比较,差异有统计学意义(P<0.05);肠外营养组和肠内营养组患者血清白蛋白、血红蛋白、丙氨酸转氨酶及天冬氨酸转氨酶水平组间比较差异无统计学意义;肠内营养组患者疗后血清白蛋白、血红蛋白、丙氨酸转氨酶及天冬氨酸转氨酶指标分别为(35.5±6.1)g/L、(90.2±10.4)g/L、(63.7±8.8)U/L、(73.3±13.7)U/L,均明显优于肠外营养组的(39.7±7.5)g/L、(99.6±13.8)g/L、(37.1±6.2)U/L、(36.4±7.4)U/L,组间比较差异有统计学意义(P<0.05);同时肠内营养组患者术后排气时间及体重下降指标分别为(67.2±5.0)h、(1.9±0.5)kg,均明显优于肠外营养组的(90.8±7.5)h、(2.6±1.0)kg,组间比较差异有统计学意义(P<0.05)。结论食管癌术后早期肠内营养可有效改善术后营养水平,降低肺部感染发生风险,具有临床使用价值。

OBJECTIVE To investigate clinical preventive effects of early enteral nutrition on lung infections after esophageal cancer surgery so as to guide the clinical treatment.METHODS Totally 50children with surgical resection of esophageal cancer were chosen from the hospital in the period from May 2011to May 2012and were randomly divided into two groups including the parenteral nutrition group（25children）with parenteral nutrition support and the enteral nutrition group（25children）with enteral nutrition support by nose intestinal infusion,then the incidence of pulmonary infections and the levels of serum albumin,hemoglobin,alanine aminotransferase and aspartate aminotransferase before and after the treatment,exhaust time after surgery,and weight loss were compared between the two groups.RESULTS The incidence of pulmonary infections of the enteral nutrition group was 32.0%,significantly higher than 12.0%of the parenteral nutrition group,the difference was significant（P 0.05）;the difference in the level of serum albumin,alanine aminotransferase or aspartate aminotransferase between the enteral nutrition group and the parenteral nutrition group was not significant.After the treatment,the levels of the serum albumin（35.5±6.1）g/L,hemoglobin（90.2±10.4）g/L,alanine aminotransferase（63.7 ±8.8）U/L,and aspartate aminotransferase（73.3±13.7）U/L of the enteral nutrition group were significantly higher than the levels of the serum albumin（39.7±7.5）g/L,hemoglobin（99.6±13.8）g/L,alanine aminotransferase（37.1±6.2）U/L and aspartate aminotransferase（36.4±7.4）U/L of the parenteral nutrition group,the difference between the two groups was significant（P0.05）.The postoperative exhaust time of the enteral nutrition group was（67.2±5.0）h,significantly less than（90.8±7.5）h of the parenteral nutrition group,while the weight loss of the enteral nutrition group was（1.9±0.5）kg,significantly less than（2.6±1.0） kg of the parenteral nutrition group,the difference was significant（P0.05）.CONCLUSION The early enteral nutrition can efficiently improve the nutrition level of the patients after esophageal cancer surgery and lower the risk of pulmonary infections,it is worthy of the clinical application.