全腔镜食管癌切除术后早期肠内营养时机及效果的探讨

Effects and timing exploration of early enteral nutrition after thoracoscopic resection of esophageal cancer

目的：探讨全腔镜食管癌术后早期肠内营养支持的最佳时机及其对患者术后恢复情况的影响。方法选取2012年7月—2014年11月在福建医科大学附属协和医院胸外科行手术治疗的食管癌患者202例,按照随机数字表法将患者分成观察组88例和对照组114例。分别于术后8～12 h,24～48 h给予肠内营养。比较两组患者术前1 d、术后第5天、第8天血生化主要营养指标,观察两组患者临床营养支持效果和并发症发生情况。结果术后第5天观察组患者总蛋白及白蛋白含量分别为（57.44±4.61）,（29.53±3.05）g/L,均高于对照组的（53.58±5.22）,（27.13±3.27）g/L,差异有统计学意义（t值分别为5.48,5.33；P〈0.01）。术后第8天观察组患者的总蛋白和白蛋白含量分别为（63.30±4.80）,（32.33±3.88）g/L,均高于对照组的（57.42±5.73）,（29.75±3.66）g/L,差异有统计学意义（t值分别为7.75,3.35；P〈0.01）。对照组有24例患者发生并发症,观察组有16例,两组患者术后并发症的发生率比较,差异无统计学意义（χ2=0.26,P=0.612）。对照组出现胃肠道不适26例,观察组21例,两组患者胃肠道不适发生率比较,差异无统计学意义（χ2=0.03,P=0.860）。结论术后8～12 h内是给予肠内营养的最佳时机,能有效改善患者营养状况且对术后并发症无影响,具有临床可行性。

Objective To explore the best time of initiating enteral nutrition for patients after thoracoscopic resection of esophageal cancer and impacted on Prognosis. Methods A total of 202 esophageal cancer patients were treated in Department of Thoracic Surgery Fujian Medical University Union Hospital, who were divided into experimental group （ n =88 ） and control group （ n =114 ） by random number table and received enteral nutrition 8-12 h and 24-48 h respectively after operation. At 1 d before operation, 5 d, 8 d after operation, we compared the main nutrition indexes of blood chemistry, and observed the effects of clinical nutrition support and incidence of complications. Results Five days after operation, the total protein and＆amp;nbsp;albumin of experimental group were （57. 44 ± 4. 61）, （29. 53 ± 3. 05） g/L higher than （53. 58 ± 5. 22）, （27. 13 ± 3. 27）g/L of the control group （t=5. 48, 5. 33;P〈0. 01）; they were （63. 30 ± 4. 80）,（32. 33 ± 3. 88）g/L in the experimental group higher than （57. 42 ± 5. 73）, （29. 75 ± 3. 66） g/L in the control group （t=7. 75, 3. 35;P〈0. 01）. The incidence rate of complication in two groups had no statistical significance （P〉0. 05）. There were 24 cases complications in the control group and 16 cases in the experimental group （χ2 =0. 26,P=0. 612）. The discomfort patients of gastrointestinal tract was 26 in the control group while it was 21 persons in the experimental group （χ2 =0. 03,P=0. 860）. Conclusions The best time of enteral nutrition after operation is 8-12 hours, which can improve the nutritional status of patients and decrease postoperative complications with the clinical feasibility.