术前肠内营养对食道狭窄食管癌患者术后感染及营养指标的影响

Effect of preoperative enteral nutrition on postoperative infections and nutritional indices in esophageal cancer patients with esophageal stenosis

目的:探讨术前肠内营养支持对食道狭窄食管癌患者术后感染及营养指标的影响.方法:58例食道狭窄食管癌患者随机分为两组,试验组(n=29)术前第14天开始予以肠内营养制剂能全力,对照组(n=29)予以等热卡量日常饮食及肠外营养支持;统计术后肺感染、切口感染及吻合口瘘发生率;于术前第14天、术前第1天及术后第7天,进行血清白蛋白、血红蛋白、转铁蛋白含量测定及淋巴细胞计数.结果:试验组出组5例,对照组出组5例.试验组(n=24)术后肺感染、切口感染发生率低于对照组(n=24)(4.17%vs 16.67%,8.33%vs20.83%,均P>0.05),吻合口瘘发生率显著低于对照组(0%vs 16.67%,P<0.05).试验组术前第1天血红蛋白、转铁蛋白、淋巴细胞计数均高于对照组(123.36 g/L±6.41 g/Lvs 120.49g/L±7.17 g/L,2.34 g/L±0.40 g/L vs 2.12 g/L±0.44 g/L,2.24×109/L±0.50×109/L vs 2.05×109/L±0.47×109/L,均P>0.05),血清白蛋白显著高于对照组(37.69 g/L±2.43 g/Lvs 36.21g/L±1.87 g/L,P<0.05).试验组术后第7天血清白蛋白、血红蛋白、转铁蛋白、淋巴细胞计数均显著高于对照组(36.77 g/L±2.07 g/L vs 34.51 g/L±1.49 g/L,118.34 g/L±6.19 g/L vs 113.93 g/L±6.85 g/L,2.01 g/L±0.37 g/L vs1.77 g/L±0.34 g/L,2.80×109/L±0.51×109/L vs 2.36×109/L±0.49×109/L,均P<0.05).结论:术前肠内营养能有效改善食道狭窄食管癌患者术前及术后营养状况,对降低术后肺感染、切口感染发生率有益,能有效降低术后吻合口瘘的发生率.

AIM： To investigate the effect of preoperative enteral nutrition on postoperative infections and nutritional indices in esophageal cancer patients with esophageal stenosis. METHODS： Fifty-eight esophageal cancer pa- tients with esophageal stenosis were randomly divided into either an experimental group （n = 29） or a control group （n = 29）. The experimental group received enteral nutrition （Nutrison Fibre） on the 14th preoperative day, and the control group received isocaloric amount of daily diet and parenteral nutrition. The incidences of post- operative pulmonary infection, wound infection and anastomotic leakage were observed. Albu- min, hemoglobin, transferrin and lymphocyte count were recorded on the 14th, 1st preopera-tive days and 7th postoperative day RESULTS： In total, 24 cases in the experimental group and 24 cases in the control group were evaluable. The incidences of lung infection and wound infection were lower in the experimental group than in the control group, but the dif- ferences were not significant （4.17% vs 16.67%, 8.33% vs 20.83%, both P 〉 0.05）. The incidence of anastomotic leakage was significantly lower in the experimental group than in the control group （0% vs 16.67%, P 〈 0.05）. On the 1st pre- operative day, hemoglobin, transferrin and lym- phocyte count in the experimental group were higher than those in the control group, but the differences were not significant （123.36 g/L ± 6.41 g/L vs 120.49 g/L ± 7.17 g/L, 2.34 g/L ± 0.40 g/L vs 2.12 g/L ± 0.44g/L, 2.24 × 10^9/L ± 0.50 × 10^9/L vs 2.05 × 10^9/L ± 0.47 × 10^9/L, all P 〉 0.05）. In contrast, serum albumin was significantly higher in the control group （37.69 g/L ± 2.43 g/ L vs 36.21 g/L ± 1.87 g/L, P 〈 0.05）. On the 7th postoperative day, serum albumin, hemoglobin, transferrin and lymphocyte count in the experi- mental group were significantly higher than those in the control group （36.77 g/L ± 2.07g/L vs 34.51 g/L ± 1.49 g/L, 118.34 g/L ± 6.19 g/L vs 113.93 g/L ± 6.85 g/L, 2.01 g/L ± 0.37 g/L vs 1.77 g/L ± 0.34 g/L, 2.80 × 10^9/L ± 0.51 × 10^9/L vs 2.36 × 10^9/L ± 0.49 × 10^9/L, all P 〈 0.05）.CONCLUSION： Preoperative enteral nutri- tion can effectively improve preoperative and postoperative nutritional status and reduce the incidence of postoperative pulmonary infection, wound infection, and anastomotic leakage in esophageal cancer patients with esophageal ste- nosis.