围手术期肠内营养在肝癌精准切除患者中的价值研究

The effect of perioperative enteral nutritional support for the liver cancer patients undergoing precise resection under fast track process model

目的:评估快速康复模式下肝癌精准切除患者围手术期肠内营养应用的疗效。方法:将82例患者随机分为肠内营养组(n=41)及肠外营养组(n=41)。比较两组患者术前3 d及术后7 d营养及免疫指标的变化;记录术后肛门排气排便时间及住院时间;观察消化道不良反应及统计并发症发生例数。结果:肠外营养组营养及免疫指标术后7 d较术前3 d均降低,其中以血红蛋白(HB)(P<0.05)及总蛋白(TP)、白蛋白(ALB)(P<0.01)较显著;而对术后7 d与术前3 d的各项指标降幅相比,肠内营养组较肠外营养组的TP及ALB降幅明显减少(P<0.05)。肠内营养组肛门排气排便平均时间分别比肠外营养组提前15.1h和27.9 h,不良反应总体发生率显著降低(17.3%比40.4%,P<0.05);肠内营养组并发症发生率均低于肠外营养组(P>0.05)。结论 :对其存在营养风险的肝癌精准切除患者,快速康复模式下围手术期应用肠内营养有利于改善其临床结局。

Objective To evaluate the effect of enteral nutritional support for the liver cancer patients with precise hepatetomy under fast track process model. Methods 82 patients were prospectively randomized into enteral nutrition group （n = 41） and parenteral nutrition （n = 41）. The hemoglobin （HB）, total protein （TP）, albumin （ALB） and total lymphocyte count （TLC） were measured on 3 days before operation and 7 days after operation respectively. The two groups were compared in terms of time for anal exhaust and defecation after surgery , the postoperative hospital stay, the gastrointestinal adverse reactions and complications after surgery. Results The nutrition and immunity indicators on day 7 after operation were significantly poorer and lower than on day 3 before operation in the parenteral nutrition group （P〈0.05）; the declines of TP and ALB were significantly contained in the enteral nutrition group （P〈0.05）. The time for anal exhaust and defecation in the enteral nutrition group was advanced 15.1 h and 27.9 h on average, compared to the parenteral nutrition group and control group, respectively. The rate of adverse reaction was significantly lowered （17.3%vs. 40.4%, P〈0.05）. The rate of complications in the enteral nutrition group was significantly lower than the parenteral nutrition group （P〉0.05）. Conclusion Enteral nutritional support under fast track process model for the liver cancer patients undergoing precise resection could improve clinical outcome.