早期肠内营养联合优化护理对结直肠肿瘤术后康复的影响

Effect of early enteral nutrition combined with optimal nursing on postoperative rehabilitation of colorectal cancer

目的 :探讨早期肠内营养联合优化护理对结直肠肿瘤切除术后营养状态及康复的影响。方法 :选取2016年07月至2017年12月于我科行结直肠肿瘤切除的116名病人,随机设立对照组和试验组各58例。对照组予以肠外营养支持,并实施常规的外科术后护理;试验组给予早期肠内营养支持,同时进一步优化护理干预,其中包括细化术前指导、加强术前身体活动和耐力训练、疼痛护理、术后尽早恢复饮水、鼓励病人尽早下床活动、早期拔除尿管等。结果 :术后第7天,试验组病人与对照组病人相比,体质量(P=0.010)、血红蛋白(P=0.016)、前清蛋白(P <0.001)、血清白蛋白(P <0.001)等营养指标明显升高。同时,试验组第5、7天白细胞及C反应蛋白水平低于对照组。经优化护理后,试验组相较于对照组病人并发症发生率降低,肠鸣音恢复时间(P <0.001)、肛门排气时间(P=0.001)以及排便时间明显缩短(P <0.001)。此外,研究发现,早期肠内营养联合优化护理能够明显缩短住院时间(P <0.001)。结论 :对于行结直肠肿瘤切除病人,予以早期肠内营养联合优化护理干预能够有效改善营养状况、减少术后并发症的发生,促进胃肠功能恢复,促进病人康复。

Objective： To investigate the effect of early enteral nutrition combined with optimal nursing on nutritional status and rehabilitation after colorectal cancer resection. Methods： One hundred and sixteen patients with colorectal cancer resection from July 2016 to December 2017 in our department were randomly divided into control group and experimental group. The control group was given parenteral nutrition support and routine surgical postoperative nursing; the experimental group was given early enteral nutrition support and further optimal nursing interventions, including refinement of preoperative guidance, strengthening preoperative physical activity and endurance training, pain care, returning to drinking water as soon as possible after surgery, encouraging patients to get out of bed as soon as possible, early removal of urinary catheters, etc. Results： On the 7 th day after operation, the nutritional indexes of body weight, hemoglobin, prealbumin and serum albumin in the experimental group were significantly better than those in the control group. And the levels of white blood cells and C-reactive protein on the 5 th and 7 th days of the experimental group were lower than those of the control group. After optimal nursing, complication rate, bowel sounds recovery time, anal exhaust time and defecation time in experimental group were significantly shorter than the control group. In addition, the study found that early enteral nutrition combined with optimal nursing can significantly reduce hospital stay. Conclusion： Early enteral nutrition combined with optimal nursing interventions can effectively improve nutritional status, reduce postoperative complications, promote gastrointestinal function recovery, and promote rehabilitation in the patients with colorectal cancer resection.