早期肠内营养在老年胃癌患者全胃切除术后护理中的应用

Early enteral nutrition on the nursing of elderly patient with gastric cancer after total gastrectomy

目的 探讨老年胃癌患者全胃切除术后早期肠内营养应用的临床效果.方法 采用目的抽样法选择上海交通大学医学院附属仁济医院2014年9月—2016年9月全胃切除术老年胃癌患者138例,采用随机数字表分为观察组（73例）和对照组（65例）.对照组患者在术后给予胃肠外营养支持,能量为125 KJ/（kg.d）,氮含量为0.15 g/（kg.d）,总液体量为50 ml/（kg.d）,经营养科配置成3 L袋,由颈内静脉滴入,待患者肛门排气胃管拔除后,常规给予少量饮水、清流质、流质、半流质逐渐过渡到正常饮食.观察组给予留置三腔喂养管,术后12 h给予5%葡萄糖溶液100 ml,由三腔喂养管加温滴入,24 h后给予瑞代（肠内营养混悬剂）500 ml滴入,每天增加500 ml,术后4 d左右增加到1500 ml/d;滴注速度每天增加20 ml/h直到100 ml/h.比较两组患者的术后并发症发生率、肛门排气时间、首次下床时间、住院天数、营养指标情况.结果 观察组平均住院天数、肛门排气时间、首次下床活动时间分别为（12.9±5.9）d、（70.3±16.7）h、（15.24±13.28）h,均低于对照组[（18.6±6.9）d、（97.5±22.3）h、（29.95±15.23）h],差异有统计学意义（P〈0.05）.观察组发生1例腹泻,对照组发生2例吻合口瘘、2例感染、1例梗阻、2例腹泻,观察组并发症发生率低于对照组,差异有统计学意义（P〈0.05）.术后7、14 d观察组的营养指标均优于对照组,差异有统计学意义（P〈0.05）.结论 老年胃癌患者全胃切除术后给予早期肠内营养能减少术后并发症的发生,改善患者术后的营养状态,促进患者早期下床,缩短肛门排气时间,减少住院天数.

Objective To discuss the clinical effects of early enteral nutrition on elderly patient with gastric cancer after total gastrectomy. Methods A total of 138 elderly patients with gastric cancer after total gastrectomy in Renji Hospital Shanghai Jiaotong University School of Medicine from September 2014 to September 2016 were selected using purposive sampling. They were divided into the observation（n=73）and control（n=65）groups using random number table. Patients in the control group were given parenteral nutritional support. The energy was 125 KJ/（kg.d）;nitrogen content was 0.15 g/（kg.d）;total fluid amount was 50 ml/（kg.d）. They were prepared to bags of 3 L and given by intravenous dripping through internal jugular vein. After the anal exhaust and removing gastric tube,patients were routinely given from water to clear fluid diet,fluid diet, semi-fluid diet until normal diet. Patients in the observation group received indwelling three-lumen gastrojejunal tube. At 12 h after the operation,heating 100 ml 5% glucose were given through three-lumen gastrojejunal tube. At 24 h after the operation,Ruidai（enteral nutritional suspension-TPF）were given at the total 500 ml and increased by 500 ml/d until 1500 ml at 4 d after the operation. The drop speed increased from 20 ml/h to 100 ml/h. The incidence of postoperative complications,the anal exhaust time,the leaving bed time,hospital days and nutritive indexes were compared between the two groups. Results The hospital days,anal exhaust time and the leaving bed time in the observation group were（12.9±5.9）d,（70.3±16.7）h and（15.24±13.28）h, which were significantly lower than those in the control group[（18.6±6.9）d,（97.5±22.3）h and（29.95± 15.23）h]（P 〈 0.05）. There was 1 case of diarrhea in the observation group,while 2 cases of anastomotic leakage,2 case of infection,1 case of obstruction and 2 cases of diarrhea were observed in the control group. The incidence of postoperative complications in the observation group was significantly lower than that in the control group（P 〈 0.05）. The nutritive indexes at 7 d and 14 d after the operation in the observation group were statistically significantly better than those in the control group（P 〈 0.05）. Conclusions Early enteral nutrition on elderly patient with gastric cancer after total gastrectomy can reduce the incidence of postoperative complications,improve the postoperative nutrition status,shorten the time of anal exhaust and leaving bed,and reduce the hospital days.