胃癌病人术后早期肠内营养不耐受的风险因素及对预后影响

Risk factors and effects of intolerance of early enteral nutrition after surgery for gastric cancer

目的:研究胃癌病人术后早期肠内营养(EEN)不耐受的风险因素及其对预后的影响。方法:选取行胃癌根治术,且术后行EEN的75例胃癌病人的病历资料,根据术后EEN实施后病人是否出现恶心、呕吐、腹痛、腹胀和腹泻的症状,将病人分为EEN耐受组和不耐受组。结果:51例(68%)胃癌病人在术后实施EEN过程中出现了EN不耐受的症状,24例(32%)早期实施EN后耐受良好。不耐受组病人的手术类型、术后第1天下床活动时间、开始EN的时间和使用营养泵与耐受组之间存在明显差异。经多元回归分析发现,病人术后第1天下床活动时间>4 h和使用EN泵是术后EEN耐受的有利因素(P<0.05)。EEN不耐受组病人术后排气、排便时间和住院时间均明显长于耐受组。结论:胃癌病人术后下床活动时间不足及未使用EN泵进行匀速输注是EEN出现不耐受的风险因素,可延缓病人术后康复。

Objective ： To investigate the enteral nutrition after surgery for gastric cancer. risk factors and prognostic effects of intolerance of early Methods： The clinical data of 75 patients with gastric cancer who were admitted in the Shoukang hospital and received early enteral nutrition after surgery were retrospectively retrived and analyzed. Patients were divided into the tolerance group and the non-tolerance group according to whether the patients developed the symtoms of nausea, vomiting, abdominal pain, dis- tention and diarrhea after early enteral nutrition. Results： 51 patients （68%） showed enteral nutrition intolerance after early enteral nutrition postoperatively, whereas 24 （32%） were in the tolerance group. The activity time out of bed on the first postoperative day, the time of initiation of enteral nutrition, and nutrition pump were significantly different between two groups. Logistic analysis revealed that the activiti- ty time and nutrition pump were independent favourable factors. Besides, patients with intolerance had longer time to exhaust and defecation, and postoperative hospital stay. Conclusion： Insufficient post- operative activity time and nonuse of nutrition pump are risk factors of intolerance of early enteral nutri- tion, which may slow the recovery of patients.