手术不可切除的上消化道恶性梗阻患者肠内营养支持

Enteral nutrition in patients with u nresectable malignant obstruction of upper digestive tract

目的探讨手术不可切除的上消化道恶性梗阻患者进行肠内营养(EN)的方法及效果。方法手术不可切除的上消化道完全恶性梗阻患者6例,术前行全肠外营养支持,然后通过手术胃造口或空肠造口,术后逐渐由肠外营养(PN)向EN过渡,并根据病情进行化疗或放疗等综合治疗。定期检查血清白蛋白、前白蛋白和转铁蛋白、体重、体质指数和进行卡氏行为状态评分(KPS)。结果6例患者均病情好转出院,平均住院天数为(35.4±10.8)d,出院后继续家庭EN支持。4例患者营养改善后,进行了放疗或化疗,其中3例梗阻获得部分缓解,可以进少量流汁饮食和水。出院时与入院时相比,血清前白蛋白、转铁蛋白浓度及KPS评分有明显改善(P<0.05)。结论上消化道恶性梗阻患者选择性地进行EN支持可以改善患者的营养状况及生活质量。

Objective To investigate the method and effect of enteral nutrition applied in pati ents with unresectable malignant obstru ction of upper digestive tract.Methods Six patients with malignant obstruction of upper digestive tract received total parenteral nutriti on before operation,then underwent gastrostomy or jejunumostomy.Afte r operation these 6cases received en teral nutrition gradually,and then chemotherapy or radiotherapy according to their conditions.Serum concentrations of albumin,prealbumin and transferrin,body weight,Karnofsky performance score(KPS)were examined regularly.Results All the patients recovered,and received home enteral nutrition after disch arge,whose average hospitalizatio n was(35.4±10.8)days.Four patients received radiotherapy or chemotherapy after nutrit ional status were improved,and the upper digestive tr act obstruction was remissed in 3cases,who could feed a few liquid diet and water.When discharge,the patie nts serum concentration of prealbum in,transferrin,and KPS were improved significantly as compared to that at admission.Conclusion Enteral nutrition can improve the nutritional status and quality of life in patients with malignant obstru ction of upper digestive tract.