术前肠内营养支持应用于伴营养风险胃癌患者的临床观察

Clinical observation of preoperative administration of enteral nutrition support in gastric cancer patients at risk of malnutrition

目的评价术前肠内营养支持应用于伴营养风险胃癌患者的临床疗效和安全性。方法前瞻性入组2012年5—10月间四川大学华西医院收治的60例伴营养风险的胃癌患者，按随机数字表法分为试验组（30例）和对照组（30例）。试验组以安素作为肠内营养制剂，术前连续服用10d，对照组进食等热量等氮的匀浆膳。检测患者入院时、术前1d和术后3d营养相关指标及肝肾功能指标，并记录恶心、呕吐等围手术期不良反应的发生情况。结果两组患者入院时基线水平一致（均P〉0．05）。术后3d，试验组较对照组患者血清白蛋白[（33．9±5．6）g／L比（31．0±5．3）g／L，P〈O．05]和血红蛋白水平[（103．4±7．7）g／L比（96．6±10．5）g／L，P〈0．01]均明显升高；而体质量指数、淋巴细胞计数、血糖浓度、血钾、血钠及肝、肾功能指标两组差异均无统计学意义（均P〉0．05）。两组各有2例患者出现恶心症状．各有1例出现呕吐症状，试验组患者未出现肠内营养相关的严重不良临床事件。结论术前肠内营养支持应用于伴营养风险胃癌患者疗效显著，安全性高，是临床纠正营养风险的合理选择。

Objective To evaluate safety and efficacy of preoperative administration of enteral nutrition support in gastric cancer patients at risk of malnutrition. Methods A single center randomized controlled clinical trial was performed in 60 gastric cancer patients in West China Hospital from May to October 2012. Thirty patients were given enteral nutrition support （Ensure~） manufactured by Abbott Laboratories for ten consecutive days before surgical operation in the treatment group, and 30 patients were given an isocaloric and isonitrogenous homogenized diet in the control group for 10 days as well. The laboratory parameters of nutritional status and hepatorenal function were observed and compared between the two groups on admission, preoperative day 1 and postoperative day 3, respectively. Clinical Observations, such as nausea and vomiting, were carried out until patients were discharged. Results Before the intervention, there were no significant differences in the baseline characteristics between the two groups. The levels of serum albumin [（33.9：i：5.6） g/L vs. （31.0±5.3） g/L, P〈0.05], and hemoglobin [（103.4 ±7.7） g/L vs. （96.6 ±10.5） g/L, P〈0.01] were significantly improved in the treatment group on postoperative day 3. However, the levels of body mass index, lymphocyte count, liver and renal function, serum glucose, sodium, and potassium were not significantly different between the two groups （all P〉0.05）. Moreover, two patients with nausea and one with vomiting in each group were found. In clinical observation period, no severe treatment-related adverse event were observed. Conclusion The enteral supplement with Ensure R in gastric cancer patients at risk of malnutrition during preoperative period is effective and safe, which is superior to homogenized diet and an appropriate choice for gastric cancer patients with nutritional risk.