食管癌术后肠内营养支持的临床效果及其耐受性观察

Observation on clinical efficacy and tolerance of postoperative enteral nutrition support in patients with esophageal cancer

目的了解食管癌术后肠内营养支持的临床效果和耐受性。方法 95例食管癌患者被随机(采用随机数字表法)分为肠内营养组54例和肠外营养组41例,肠内营养组在食管癌术后进行肠内营养支持,肠外营养组在术后进行全肠外营养支持。在术前和术后观察2组的体质量、血红蛋白和血清白蛋白水平,术后观察2组的首次肛门排气时间和首次肛门排便时间。观察2组出现的不耐受病例,并分析患者耐受性的影响因素。结果肠内营养组术后的体质量、血红蛋白和血清白蛋白均高于肠外营养组术后(t=1.778、1.696、1.823,P均<0.05)。肠内营养组术后的首次肛门排气时间、首次肛门排便时间均低于肠外营养组(P均<0.05)。肠内营养组在(2.4±0.6)d开始输入肠内营养液,过渡到目标用量时间(4.6±0.9)d。在营养支持过程中,肠内营养组的不耐受率为31.5%(17/54),肠外营养组的不耐受率为24.4%(10/41);2组的不耐受率差异无统计学意义(χ2=0.576,P>0.05)。肠内营养组中不同性别、不同年龄、不同术中出血量、不同过渡到目标用量时间、不同首次输入量的患者不耐受率的差异均无统计学意义(P均>0.05)。结论食管癌术后行肠内营养支持可有效改善患者的营养状况,且耐受性良好,具有较好的临床应用价值。

Objective To investigate the clinical efficacy of enteral nutrition support and the tolerance of patients with esophageal cancer after the surgery. Methods Total 95 patients with esophageal cancer were randomly divided into enteral nutrition group（ 54 cases） and parenteral nutrition group（ 41 cases）. The enteral nutrition group received the enteral nutrition support after the operation,while the parenteral nutrition group received the total parenteral nutrition support after the surgery. The body weight and the levels of hemoglobin and serum albumin of both groups before and after the operations were compared,and the time to first passage of flatus and stool of the two groups were recorded,the intolerance and influencing factors in both groups were observed and analyzed. Results The postoperative body weight,levels of hemoglobin and serum albumin of the enteral nutrition group were higher than those of the parenteral nutrition group（ t = 1. 778,1. 696,1. 823,P 〈 0. 05）. After the surgery,the first time to first passage of flatus and stool of the enteral nutrition group were lower than those of the parenteral nutrition group（ P 〈 0. 05）. The enteral nutrition group was administrated with enteral nutrition solution at（ 2. 4 ± 0. 6） d after the operations,and got the target dosage within（ 4. 6 ± 0. 9） d. In the process of nutritional support,the intolerance rate of the enteral nutrition group was 31. 5%（ 17 /54）,and of the parenteral nutrition group was 24. 4%（ 10 /41）,the difference was not significant between the two groups（ χ2= 0. 576,P 〉 0. 05）.There were no significant differences in the intolerance among the patients with different sex,age,the amount of blood loss,the different time of getting the target dosage and the amount of the first input in the enteral nutrition group（ P 〉0. 05）. Conclusion The postoperative enteral nutrition support can effectively improve the nutritional status of patients with esophageal cancer,and maintain a good tolerance. The therapy may be widely used in clinic.