胃癌根治术后早期肠内营养支持的开始时间研究

Study of start time of early enteral nutritional support in patients with radical gastrectomy

目的探讨胃癌术后对患者进行早期肠内营养(enteral nutrition,EN)支持的开始时间。方法选取2008年10月—2013年10月间外科收治的胃癌手术患者79例,随机分成实验组(术后12 h组,n=40)和对照组(术后48 h组,n=39),通过手术中留置的鼻肠管,分别于术后12 h、48 h给予患者肠内营养支持。手术后常规监测患者生命体征,观察并记录患者胃肠道功能恢复情况和术后7 d的生化指标(肝功能、肾功能、血常规、血糖等),对2组患者住院时间进行比较。结果术后患者恢复顺利,实验组较对照组肠蠕动恢复时间提前,首次排气时间提前(P<0.05),虽然主诉腹胀隐痛的人数增加(P<0.05),但腹部不适症状大多较轻微并可耐受,给予解痉等即可处理。实验组患者术后住院时间短于对照组(P<0.05)。对比实验组和对照组患者术后7 d肝功能、肾功能、血常规、血糖等生化指标,2组差异无统计学意义(P>0.05)。结论胃癌术后12 h对患者开始实施早期肠内营养支持可促进机体胃肠道功能恢复,缩短患者住院时间,且对重要脏器功能与营养指标无不良影响,不会影响机体正常生理活动,安全可行。

Objective To discuss the start time of early enteral nutritional（EN） support in the patients undergoing radical gastrectomy. Methods Total 79 patients undergoing radical gastrectomy in our department from October 2008 to October 2013 were selected and divided randomly into experimental group （12 h after surgery, n = 40） and control group （48 h after surgery, n = 39）. The EN was started by naso-intestinal tube in 12 hours after the operation in the experimental group, and in 48h after the operation in the control group. The vital signs of patients were monitored routinely after surgery. The recovery of gastrointestinal function was observed and recorded. While the blood count, liver function, kidney function, blood glucose, electrolytes and other biochemical markers were tested for 7 post-operative days. The hospital stay of both groups was compared. Results All patients recovered smoothly after the surgery. Compared with the control group, the bowel recovery quickly, the first flatus time was shorter. The incidence of abdominal distension and abdominal pain was in- creased in the experimental group （ P 〈 0.05 ）, but the abdominal distension and abdominal pain were mostly mild and well tolerated,the anticonvulsant treatment relieved their symptoms. The postoperative hospital stay of the experimental group was shorter than the control group （ P 〈 0.05 ）. The blood oount,liver function, kidney function, blood glucose, electrolytes and other biochemical markers for 7 post-operative days were not significantly different between the two groups （P 〉 0.05 ）. Conclusion The early enteral nutritional support that starts in 12 hours after the operation in patients with radical gastrectomy can promote the recovery of gastrointestinal function, shorten hospital stay, and has no adverse effect on vital organ function, nutritional indicators and body＇ s normal physiological activities, so it was safe and feasible.