早期肠内营养对老年胃癌患者全胃切除术后身体状况的影响

Effect of early enteral nutrition on elderly patients with gastric cancer after total gastrectomy

目的：探讨早期肠内营养（ Early enteral nutrition，EEN）对老年胃癌患者全胃切除术（ Total gastrec-tomy，TG）后身体状况改善的影响。方法选择2012年4月至2014年1月在我院接受TG术的老年胃癌患者76例，按患者术后营养支持方式的不同分为EEN组和PN组各38例。统计两组患者术后肠功能恢复时间、住院时间、并发症发生情况及手术10 d后的营养指标〔血清白蛋白（ ALB）、转铁蛋白和24h尿素氮（24hUP）〕和免疫功能指标（ CD3、CD4、CD8、CD4／CD8和NK细胞活性）。结果 EEN组患者的肛门排气时间、肛门排便时间和住院时间分别为（53.5±10.2）h、（78.7±15.4）h和（13.6±3.4）d， PN组分别为（66.7±11.5）h、（114.2±13.6）h和（21.5±3.5）d，两组相比，差异具有统计学意义（P＜0.05）；EEN组患者的并发症发生率为13.2％（5／38），PN组并发症发生率为34.2％（13／38），差异具有统计学意义（P＜0.05）；EEN组患者手术7 d后的营养指标和免疫功能指标均明显优于PN组，两组比较差异具有统计学意义（ P＜0.05）。结论对老年胃癌患者术后给予EEN的营养支持方式安全有效，有利于患者免疫功能的恢复和临床症状的改善，值得在临床上进一步推广。

Objective To explore the effect of early enteral nutrition （ EEN） on elderly patients with gastric cancer after total gastrectomy （ TG） .Methods A total of 76 cases of elderly patients with gastric cancer accepted TG in our hospital from April 2012 to January 2014 were selected, according to different ways for postoperative nutritional support, patients were divided into EEN group with 38, patients received EEN support, and parenteral nutrition （PN） group with 38 patients treated with conventional deep vein PN.Statistics postoperative bowel function recovery time hospital stay and complications in patients, as well as nutritional indicators （serum protein ALB, transferrin and 24h urea nitrogen （24hUP）） and immune function index （CD3, CD4, CD8, CD4/CD8 and NK cell activity） at 10d after surgery were recorded and compared.Results Time of anal exhaust, time of anal defecation and hospital stay in the EEN group were （53.5±10.2） h, （78.7±15.4） h and （13.6±3.4） d, and were （66.7±11.5） h, （114.2±13.6） h and （21.5±3.5） d in PN group, the differences were statistically significant （P〈0.05）;complications in EEN group was 13.2% （5/38 ） , and was 34.2% （ 13/38 ） in the PN group, the difference was statistically significant （ P〈0.05）;nutrition indicators and immune function indicators 7 d after surgery in EN group were significantly better than those in the PN group, the difference was statistically significance （ P〈0.05 ） .Conclusions Given EEN nutritional support to elderly patients with gastric cancer after surgery is safe and effective, and is benefit to immune function recovery and clinical signs improvement, thus worthy of further promotion in clinical practice.