胃癌手术患者术后肠内营养输注方案研究

Study of infusion methods of postoperative enteral nutrition in patients with gastric cancer

目的:探讨胃癌手术患者肠内营养的输注方案。方法:选取行胃癌根治术的86例患者为研究对象,随机分为持续性输注组和周期性输注组,每组43例。持续性输注组24 h持续性进行肠内营养,周期性输注组每日肠内营养输注时间为15~17 h。比较两组的肠内营养支持结果,手术前后肱三头肌皮褶厚度、上臂中点的周径、握力等身体指标,血清总蛋白(TP)、血红蛋白(Hb)、白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TF)等营养指标,免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、分化抗原4(CD4^+)、分化抗原8(CD8^+)、分化抗原4/分化抗原8(CD4^+/CD8^+)的浓度等免疫指标。结果:持续性输注组和周期性输注组分别出现1例(2.3%)、3例(7.0%)肠内营养不耐受,两组差异无统计学意义(P>0.05)。持续性输注组过渡到全肠内营养的时间、拔管进行自主进食的时间均显著少于周期性输注组,差异有统计学意义(P<0.05)。两组术前身体、营养及免疫指标比较,差异无统计学意义(P>0.05);持续性输注组术后第5天、第10天PA显著高于周期性输注组(P<0.05);其余术后各时间点两组的身体、营养及免疫指标比较,差异无统计学意义(P>0.05)。结论:与周期性输注相比,持续性输注方式缩短了胃癌术后患者过渡到全肠内营养的时间及拔管时间,营养状况的改善效果更显著,值得临床推广应用。

Objective： To investigate the infusion methods of postoperative enteral nutrition in patients with gastric cancer. Methods： 86 patients with gastric cancer received radical operationin our hospital from January 2014 and December 2015 were enrolled for the study and randomly divid- ed into continuous infusion group and periodic infusion group, each group with 43 cases. Patients in continuous infusion group were given postoperative continuous enteral nutrition for 24 h in one day, while cases in periodic infusion group were given postoperative continuous enteral nutrition for15-17 h in one day. Results of enteral nutrition, physical indicators including upper arm skinfold, di- ameter of midpoint of upper arm and grip strength, nutritional indexes including total protein （TP）, hemoglobin （Hb）, albumin （AIb）, preaLbumin （PA） and transferrin（TF）, immune indicators including im- munoglobulin G（IgG）, immunoglobulin M （IgM）, immunoglobulin A （IgA）, CD4＋, CD8＋ and CD4＋/CD8＋ were compared between two groups before and after operation. Results： intolerance of enteral nu- trition occurred in 1 case（2.3%） of continuous infusion group and 3 cases（7.0%） of periodic infusion- group, and there was no significant difference between them （P〉0.05）. Time of transition to full en- teral nutrition and taking off the tube to self-feeding incontinuous infusion group were significantly smaller than that in periodic infusion group （P〈0.05）. There were no significant difference in baseline data, physical indicators, nutritional indexes and immune indicators between them before operation （P〉0.05）. PA level at 5 d, 10 d after operation in continuous infusion group were significantly higher than that in periodic infusion group （P〈0.05）, and there were no significant difference in physical indi- cators, other nutritional indexes and immune indicators between them after operation（P〉0.05）. Con. clusion： Compared with periodic infusion, continuous infusion method could shorten the time of transition to full enteral nutrition and taking off the tube to self-feeding in patients after radical oper- ation of gastric cancer, and had more significant effect of improvement of nutritional status, worthy of clinical popularization and application.