术前肠内营养对有营养风险的消化道恶性肿瘤患者的临床研究

Clinical study of preoperative enteral nutrition on malignant digestive tumors patients with nutritional risk

目的 探讨术前肠内营养支持对于存在营养风险的消化道恶性肿瘤患者的临床疗效.方法 前瞻性分析北京协和医院基本外科2015年1-6月收治的消化道恶性肿瘤患者的临床资料.患者术前经NRS 2002营养风险筛查,筛选出有营养风险的患者73例,将患者依据是否给予术前肠内营养支持分为肠内营养组31例和对照组42例.肠内营养组术前给予口服或管饲肠内营养制剂7～10d;对照组术前正常进食.两组患者术后均给予静脉营养支持,比较两组患者入院时及手术前体重、BMI、血清总蛋白、白蛋白、前白蛋白等指标变化情况,以及术后并发症的发生率.计量资料以均数±标准差（（x）±s）表示,人院时组间比较采用t检验,入院时和手术前比较采用配对t检验;计数资料以频数和百分数（％）表示,组间比较采用χ^2检验或Fisher确切概率法.结果 肠内营养组患者对于肠内营养耐受良好,经术前肠内营养支持后体重、BMI、血清总蛋白、白蛋白、前白蛋白等营养指标较入院时明显改善,差异具有统计学意义（P＜0.05）.肠内营养组术后伤口愈合不良、肺部感染及吻合口漏的发病率分别为9.68％、6.45％、3.23％;明显低于对照组（14.4％、11.9％、7.14％）,但差异无统计学意义（P＞0.05）.结论 术前肠内营养支持对于消化道恶性肿瘤患者是安全、可行的,对于改善患者营养状况,减少由于营养风险带来的手术并发症有一定的帮助.

Objective To assess the effect of preoperative enteral nutrition on malignant digestive tumors patients with nutritional risk.Methods A prospective clinical study was conducted on 73 malignant digestive tumors patients who were admitted in Department of General Surgery,Peking Union Medical College Hospital from January to June in 2015.Seventy-three patients were screened preoperatively by NRS 2002 and then divided into two groups：enteral nutrition group （n =31） and control group （n =42）.Patients in enteral nutrition group were given oral or tube feeding elemental diet for 7-10 days before operation.Patients in control group ate normally.Both patients were given intravenous nutritional support postoperatively.The data of body weight,body mass index,blood total protein,albumin,pre-albumin and incidence of postoperative complications were compared on admission and before operation.Measured data were expressed as （x） ± s.The t-test was used to compare the indexes between groups.The paired t-test was used for comparison between admission and before surgery;the count data were expressed as frequency and percentage （%）,comparison between groups use Chi-square test or Fisher＇s exact probability method.Results The nutritional status including body weight,body mass index,blood total protein,albumin and pre-albumin were significantly improved pre-operatively in enteral nutrition group （P 〈 0.05）,and postoperative complications including wound dehiscence,pneumonia and anatomotic leakage in enteral group were 9.68%,6.45% and 3.23% separately,which were less than that in control group （14.4%,11.9% and 7.14%）,however,the result was not significantly different （P 〉 0.05）.Conclusion Pre-operative enteral nutrition is safe and efficacy,which is helpful for malignant digestive tumors patients with nutritional risk.