全程营养治疗对于食管癌患者术后体质成分的影响

Effect of whole-course nutrition therapy on postoperative constitutional components in patients with esophageal cancer

目的探讨全程营养治疗对食管癌患者术后体质成分改变的影响及意义,为制定科学的营养治疗方案提供理论依据。方法选取2017年8月至2018年8月期间在东部战区总医院行食管癌根治术的患者136例,采用信封法随机分为全程营养组(接受全程营养治疗)和常规治疗组(接受常规治疗)。所有患者分别于入院时(第1次测量)、术后1周(第2次测量)、出院后1个月(第3次测量)时行人体成分分析仪(InBody S10,Korea)检查,并比较患者早期(第2次测量和第1次测量的差异)和后期(第3次测量和第2次测量的差异)的体质成分变化。同时观察研究期间肠内营养液耐受性情况、病死率、手术后感染性并发症和吻合口瘘的发生率及术后住院时间。结果 2组患者术后早期体成分差异主要表现在下肢的肌肉及水分(P<0.01),而其他体质成分的改变差异无统计学意义(P>0.05)。后期,全程营养组患者较常规治疗组在体重的变化[(-1.41±2.71)kg vs(-4.61±1.99)kg,P<0.001]、去脂体重的变化[(-4.26±3.07)kg vs(-5.46±3.61)kg,P=0.043]、肌肉量的变化[(-3.81±2.92)kg vs(-5.20±3.48)kg,P=0.024]差异均有统计学意义,其术后住院时间较常规治疗组也明显缩短[(8.7±1.9)d vs(10.2±2.3)d,P<0.05]。结论食管癌患者术后体质成分丢失主要发生在出院后,全程营养治疗能显著改善食管癌患者术后的营养状况,缩短住院时间,为患者术后的综合抗肿瘤综合治疗提供有利的身体条件,对拟行食管癌外科治疗的患者营养支持方案的制定有指导意义。

Objective To investigate the effect and significance of whole-course nutritional therapy on the changes of postoperative constitutional components in patients after esophagectomy,and to provide a theoretical basis for the development of scientific nutritional treatment programs.Methods A total of 136 patients who underwent esophageal cancer radical mastectomy at the General Hospital of Eastern Theater Command from August 2017 to August 2018 were recruited.All patients were randomly grouped into a whole-course nutrition group and a conventional treatment group by envelope method.The experimental group received whole-course nutritional therapy and the control group received routine treatment.All patients were examined with body composition analyzer(InBody S10,Korea)physique at admission(the first measurement),one week after surgery(the second measurement),and 1 month after discharge(the third measurement),The changes of the physical composition of the patient in the early(difference between the second measurement and the first measurement)and later(difference between the third measurement and the second measurement). The tolerance,mortality,postoperative infectious complications,incidence of anastomotic fistula and postoperative hospitalization time of enteral nutrient solution were observed.Results The difference in body composition in the early stage of two groups of patients was mainly manifested in the muscle and moisture of the lower extremities(P<0.01),and the difference in other physical components was not statistically significant(P>0.05).At later stage,the weight loss[(-1.41±2.71)kg vs(-4.61±1.99)kg,P<0.001],free fat mass loss[(-4.26±3.07)kg vs(-5.46±3.61)kg,P=0.043],and muscle mass loss[(-3.81±2.92)kg vs(-5.20±3.48)kg,P=0.024]were superior to the conventional treatment group compared with 1 week after surgery.The postoperative hospital stay was also significantly shorter than the conventional treatment group[(8.7±1.9)d vs(10.2±2.3)d,P<0.05].Conclusion The loss of constitutional components in patients after esophagectomy mainly occurs after discharge.The whole-course nutritional therapy significantly improve the nutritional status of patients undergoing surgery for esophageal cancer and shorten postoperative hospital stay and provide favorable physical conditions for comprehensive postoperative anti-tumor treatment.The development of nutritional support programs for patients undergoing surgical treatment of esophageal cancer is instructive.