腹内压变异率与胃癌术后空肠营养耐受性的关系研究

Study on relationship between intra-abdominal pressure variation rate and postoperative jejunum nutrition tolerance of patients with gastric cancer operation

[目的]探讨腹内压（IAP）变异率与胃癌术后空肠营养的关系。[方法]选取2011年1月—2013年6月行胃癌手术病人85例,根据病人术后24hIAP的变化分为A组（24hIAP增加〉20%,n=28）、B组（24hIAP增加-20%~20%,n=33）和C组（24h IAP增加〈-20%,n=24）。比较3组病人营养指标变化以及术后通气、排便时间和空肠营养耐受性。[结果]3组术后前清蛋白、视黄醇结合蛋白、清蛋白等比较差异有统计学意义,且A组、B组术后前清蛋白、视黄醇结合蛋白、清蛋白等均较C组降低,差异有统计学意义（P〈0.05）;3组术后通气、排便时间和空肠营养耐受性比较差异有统计学意义（P〈0.05）;IAP与病人营养耐受性呈负相关（P〈0.05）;单因素分析结果显示,急性生理与慢性健康评分Ⅲ（ApacheⅢ）、IAP和年龄为营养耐受性的影响因素;多因素分析结果显示,ApacheⅢ和IAP为营养耐受性的影响因素。[结论]IAP变异率与胃癌术后病人营养耐受性相关,营养耐受性的影响因素有ApacheⅢ和IAP,IAP是评估胃癌术后空肠营养状态的重要指标之一。

Objective：To probe into the relationship between intra abdominal pressure variation rate and post-operative jejunum nutrition of gastric cancer patients.Methods：A total of 85 cases of patients with gastric cancer undergoing operation from 201 1 January to 2013 June,according to the 24 h IAP changes,the postoperative pa-tients were divided into group A （24 h IAP 〉20% increased,n =28）,group B（24 h IAP increased- 20% ~20%,n=33）and group C（24 h〈-20% IAP to increase the rent,n =24）.The nutritional index changes and postoperative ventilation,defecation time and jejunum nutrition tolerance of patients were compared among 3 groups.Results：There was statistically significant difference in postoperative prealbumin,retinol binding protein and albumin among 3 groups.The postoperative prealbumin,retinol binding protein and albumin of group A and group B were lower than those in group C,and the difference was statistically significant （P 〈0.05）;there was statistically significant difference in postoperative ventilation,defecation time and jejunum nutrition tolerance of patients among 3 groups （P 〈0.05）;IAP was negatively correlated with nutrient tolerance of patients （P〈0.05）;the single factor analysis showed that the influencing factors of nutrition tolerance included Apache III,IAP and age;multi factor analysis showed that the influencing factors of nutrition tolerance were Apache III and IAP. Conclusion：IAP variability is correlated with postoperative nutrition tolerance of patients with gastric cancer,the influencing factors of nutritional tolerance include Apache III and IAP,and IAP is one of the important indexes of assessing postoperative jejunum nutrition status of patients with gastric cancer.