胃癌患者术后早期肠内营养耐受状况及其相关因素

Tolerance of early enteral nutrition and its related factors in postoperative patients with gastric carcinoma

目的探讨胃癌患者术后早期肠内营养（EN）耐受状况及其主要影响因素。方法胃癌患者术后给予规范的EN，根据是否发生腹胀、腹泻、腹痛、反胃将患者分为EN耐受组与不耐受组，比较两组患者一般情况、手术资料及术后状况，分析影响早期EN耐受的主要因素。结果共150例患者纳入研究，其中EN耐受组与不耐受组患者分别为28例（18．7％）和122例（81．3％）。单因素分析显示，耐受组患者饮食规律性（P=0．017）、每周牛奶及豆类食品食用次数（P=0．017，P=0．003）、主食以面食为主（P=0．000）、手术当日伤口疼痛（P=0．001）和术后离床活动时间（P=0．023）与不耐受组比较差异有统计学意义。多因素Logistic回归分析显示，患者饮食规律性（OR=0．29，95％CI=0．09～0．93）、早餐规律性（OR=0．19，95％CI=0．04～0．83）、每周饮用牛奶次数（OR=0．35，95％CI=0．13—0．92）、每周豆类食品食用次数（OR=0．35，95％CI=0．12—1．00）、主食以面食为主（OR=5．81，95％CI=1．72～19．59）、手术当日伤口疼痛程度（OR=4．81，95％CI=1．77～13．08）、术后第1天下床活动时间（OR=0．21，95％CI=0．05—0．82）影响患者术后早期EN的耐受性。结论日常饮食习惯、手术当日伤口疼痛程度及术后第1天下床活动时间是影响胃癌患者术后早期EN耐受性的主要因素，饮食规律、多饮用牛奶和食用豆制品以及术后有效镇痛、术后早期较长时间的下床活动可能降低EN不耐受的发生率。

Objective To evaluate the tolerance of early enteral nutrition （EN） and its related factors among postoperative patients with gastric carcinoma. Methods All consecutive patients who had received radical surgery for gastric carcinoma in Xijing Hospital of Digestive Diseases from December 2012 to June 2013 was enrolled in this study. Based on the presence or absence of abdominal distension, abdominal pain, diarrhea, or vomiting, patients were divided into tolerance group and intolerance group. The demographic characteristics, surgical approach, complications, and intolerance symptoms were compared between these two groups using univariate and multivariate analyses. Results A total of 150 patients were enrolled in this study. Among them, 122 （81.3%） and 28 （ 18.7% ） patients were intolerant and tolerant to the early EN, respectively. Diet regularity （ P = 0. 017 ） , weekly consumption of legumes and milk （ P = 0. 017, P = 0. 003 ） , staple foods （ P = 0. 000） , postoperative pain on the day of surgery （P =0. 001 ）, and time of ambulation on the first postoperatire day （ P = 0. 023） were significantly correlated with the risk of intolerance of early EN. Conclusions Irregular daily diet, postoperative pain, and ambulation time within the first 24 hours after surgery can contribute to the intolerance of early EN. Effective postoperative analgesia and early ambulation may reduce the incidence of intolerance of early EN.