肠内营养联合聚乙二醇在结直肠肿瘤伴不全肠梗阻病人围手术期中的应用

The use of enteral nutrition agent combined polyethylene glycol in patients with colorectal cancer and incomplete intestinal obstruction in perioperation

目的:探讨口服肠内营养(EN)联合聚乙二醇对伴有不全肠梗阻的结直肠肿瘤病人行围手术期准备的可行性及疗效。方法:对结直肠癌伴有不全梗阻的病人分为两组,研究组(n=72)病人术前口服整蛋白型EN和聚乙二醇进行围手术期准备;对照组(n=105)病人术前给予流质饮食和冲服番泻叶行常规术前准备。观察两组病人术前营养评分、术中肠道清洁度、术后肛门首次排气时间、术后吻合口瘘、感染并发症、免疫指标以及血浆内毒素水平等。结果:研究组病人营养评分、肠道清洁度均好于对照组(P<0.05)。对照组病人感染并发症的发生率明显高于研究组。研究组病人术后第7天的Ig G、Ig M和CD3+、CD4+、CD8+、CD4+/CD8+水平较对照组高,术前1 d血浆内毒素含量低于对照组,两组比较均有显著性差异(P<0.05)。结论:整蛋白型EN制剂联合聚乙二醇在结直肠肿瘤伴不全肠梗阻病人围手术期中的应用,不仅术中肠道清洁度满意,而且还能改善病人术后营养和免疫功能,保护肠黏膜屏障,加速胃肠功能的恢复。

Objective ： To discuss the feasibility and curative effect of enteral nutrition agent combined PEG in patients with colorectal cancer and incomplete intestinal obstruction in perioperation. Methods ： Patients with colorectal cancer and incomplete intestinal obstruction were randomized to receive either enteral nutrition combined PEG before surgery （ n = 72） or a conventional diet including liquid diet and senna leaf （n = 105 ）. Outcomes were assessed by preoperative nutritional status, intraoperative intestinal cleanliness, postoperative exhaust time for the first time, postoperative anastomotic fistula, infectious complications, immune index and plasma endotoxin levels. Results： The study group had significantly better preoperative nutritional rating and intraoperative intestinal cleanliness （ P 〈 0.05 ）, and the control group had higher infectious complications （ P 〈 0.05 ）. There were no significant differences in postoperative anastomotic fistula and hospital stays between the two groups （ P 〉 0.05 ）. The counts of IgG, IgM,CD3^＋ , CD4^＋ ,CD8^＋ , CD4^＋/CD8^＋ level on postoperative day 7 in study group were significantly higher than those in control group, while plasma endotoxin levels on preoperative day 1 in study group was significantly lower than that of control group （ P 〈 0.05 ）. Conclusion ： Enteral nutrition agent combined PEG in patients with colorectal cancer and incomplete intestinal obstruction in perioperation can improve intestinal cleanliness, nutritional status and immune function, protect the intestinal mucosal barrier and accelerate the recovery of gastrointestinal function.