2型糖尿病合并胃肠道肿瘤术后肠内外营养支持的疗效观察

Comparative study of the enteral and parenteral nutrition with type 2 diabetic patients after gastrointestinal tumor surgery

目的探讨肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)对合并2型糖尿病(type 2diabetes mellitus,T2DM)的胃肠道肿瘤术后患者的影响。方法 86例合并T2DM的胃肠道肿瘤术后患者以数字表法随机分为EN组(术后EN支持)和PN组(术后PN支持),每组各43例,对比两组患者术后1周血糖、营养指标、胃肠功能恢复状况及术后并发症发生率。结果与术前比较,术后1周EN组空腹血糖(FPG)、餐后2小时血糖(2hPG)无明显变化(P>0.05),而PN组则显著高于术前(P<0.05),且术后1周EN组FBG、2hPG均显著低于PN组(P<0.01);术后PN组体重(BW)、总蛋白(TP)、白蛋白(ALB)、前蛋白(PA)、转铁蛋白(TFN)、血红蛋白(Hb)等营养指标均显著降低(P<0.05),且显著低于EN组(P<0.05);EN组患者术后肛门排气时间、住院时间显著短于PN组(P<0.01);EN组术后并发症发生率显著低于PN组(P<0.01)。结论 T2DM患者胃肠道肿瘤术后EN效果优于PN,胃肠道功能恢复快、并发症少,值得临床推广应用。

Objective To discuss the influence of the enteral and parenteral nutrition with type 2 diabetic （T2DM） patients after gastrointestinal tumor surgery. Methods 86 postoperative gastrointestinal tumor patients complicated with type 2 diabetes mellitus（T2DM）were randomly divided into the enteral nutrition （EN）group and the parenteral nutrition （PN） group, each group has 43 cases. EN group were given EN enternal nutrition. PN group were given PN. The blood glucose, nutritional index, recovery of gastrointestinal function and postoperative complication rate were contrasted between the two groups one week after surgery. Results Compared with preoperative, there was no significantly difference in FBG and 2 h PG in the EN group 1week after the operation（P〈0.05）, but these in PN group were significantly higher than preoperative （P〈0.05）. FBG and 2 h PG in the EN group were significantly lower than these in PN group 1 week after the operation （P〈0.01）. The nutritional indicators, including BW, ALB, PA, TFN and Hb in the PN group after the operation significantly decreased were significantly lower than these in the EN group（P〈0.05）. Anal exhaust time after the operation in the EN group was significantly shorter than that in the PN group （P〈0.01）. The postoperative complication rate in the EN group was significantly lower than that in the PN group（P〈0.01）. Conclusion The curative effect of EN on T2DM patients after gastrointestinal tumor surgery is better than that of PN. The recovery of gastrointestinal function is faster, and the incidence of postoperative complications is lower in the patients of EN group.