食管、贲门癌术后早期肠内营养的应用分析

Analysis of Early Enteral Nutrition in the Esophagus and Cardia Carcinoma After Operation

目的分析食管、贲门癌患者术后早期肠内营养对改善全身营养,促进机体恢复,预防术后并发症的作用。方法 1 353例食管、贲门癌患者随机分成肠内营养组和肠外营养组。肠内营养组均采取术中放置营养管,术后第1天开始行肠内营养。肠外营养组术后第1天开始行静脉营养支持。监测2组患者术前1 d、术后5 d、术后8 d的体质量、血浆白蛋白、尿素氮及术后并发症。结果 2组患者的体质量、血浆白蛋白及尿素氮比较差异无统计学意义(P>0.05)。在术后切口感染、皮下脂肪液化、切口裂开和吻合口瘘方面,肠内营养组优于肠外营养组(P<0.05)。肠外营养组死亡率为0.92%,肠内营养组为0.00%(P<0.05)。肠内营养组肠功能恢复时间为(59.8±8.5)h,低于肠外营养组肠的(74.4±6.3)h,比较差异有统计学意义(t=4.240,P<0.05)。结论食管、贲门癌术后早期肠内营养支持可明显减少术后并发症的发生,改善患者营养状况,促进肠功能恢复。

Objective To study the effects of early postoperative enteral nutrition support on improving the whole body nutrition, promoting the body＇ s recovery and preventing the postoperative complications for patients with e- sophagus and cardia carcinoma. Methods One thousand three hundred and fifty three patients with esophagus and cardia carcinoma were randomly divided into 2 groups： the enteral nutrition support group and the parenteral nutri- tion support group. The duodenal or jejunal feeding tubes were placed during operation in patients in the enteral nu- trition support group, and received nutritional support on day 1 after operation. The patients in the parenteral nutri- tion support group received nutrition support through vein on day 1 after operation. The body weight, the plasma al- bumin, the urea nitrogen and the postoperative complications were monitored on day 1 before operation and on day 5 and day 8 after operation. Results There was no statistical difference in the body weight, plasma albumin and urea nitrogen between the two groups （P 〉 0.05）. In the postoperative incision infection, subcutaneous fat liquefaction, incision dehiscence and anastomotic fistula, the enteral nutrition support group was better than the parenteral nutri- tion support group （P 〈 0.05）. The death rate of the enteral nutrition support group was 0.92%, and was 0.00% of the parenteral nutrition support group （ P 〈 0. 05 ）. The bowel function recovery time was （59.8 ± 8.5 ） h of the enteral nutrition support group, and was （74.4 ± 6.3 ） h of the parenteral nutrition support group （ t = 4. 240, P 〈 0.05）. Conclusion Early postoperative enteral nutrition support can significantly decrease the occurrence rate of postoperative complications, improve the whole body nutrition and promote the bowel function recovery for patients with esophagus and cardia carcinoma.