早期肠内营养支持在低位直肠癌预防性回肠造口还纳术中的应用价值

Early enteral nutrition support in preventive ileostomy closure for low rectal cancer

目的探讨早期肠内营养支持在低位直肠癌预防性回肠造口还纳术中的应用价值。方法选取南通大学附属海安医院2016年1月至2018年12月收治的120例行预防性回肠造口还纳术的低位直肠癌患者为研究对象。根据随机数字表法分为治疗组和对照组。对照组(n=60,在实施护理干预的同时实施肠外营养支持),治疗组(n=60,在实施护理干预的同时早期肠内营养支持)。比较两组的营养状况、心理状态、不良反应发生率、切口感染率、规律排便次数。结果术前,两组白蛋白、前白蛋白和血清总蛋白水平比较差异均无统计学意义(均P>0.05)。术后第7天,治疗组白蛋白、前白蛋白和血清总蛋白水平高于对照组,差异均有统计学意义(均P<0.05);两组白蛋白水平低于术前,对照组前白蛋白和血清总蛋白水平低于术前,差异均有统计学意义(均P<0.001);治疗组前白蛋白和血清总蛋白水平和术前比较差异均无统计学意义(均P>0.05)。术前,两组SAS和SDS评分比较差异均无统计学意义(均P>0.05)。术后第7天,两组SAS和SDS评分均低于术前,且治疗组SAS和SDS评分均低于对照组,差异有统计学意义(均P<0.05)。两组恶心呕吐、腹痛腹胀、腹泻、切口感染、肺部感染、腹腔感染发生率和规律排便次数比较差异均无统计学意义(均P>0.05)。结论护理干预结合早期肠内营养支持可以改善预防性回肠造口还纳患者的营养状况、负性情绪,降低不良反应发生率和切口感染率。

Objectives To investigate the effectiveness of early enteral nutrition support in preventive ileostomy closure for pa⁃tients with low rectal cancer.Methods One hundred and twenty patients who received preventive ileostomy closure for low rec⁃tal cancer treated at the Affiliated Hai’an Hospital of Nantong University between January 2016 and December 2018 were recruit⁃ed.They were randomly assigned to the treatment group and the control group.The control group(n=60)received parenteral nu⁃trition support,and the treatment group(n=60)received early enteral nutrition support.Both groups received routine nursing.We compared the two groups in nutritional status,psychological status,the incidence of adverse events,the incidence of wound infec⁃tion,and bowel routine.Results Serum levels of albumin,prealbumin,and total protein did not differ between the two groups before surgery(P>0.05).At 7 days after surgery,The levels of albumin,prealbumin,and total protein were significantly higher in the treatment group than in the control group(P<0.05).Compared to preoperative,The level of albumin decreased in both groups,the levels of prealbumin and total protein decreased significantly in the control group(P<0.001),but the levels of prealbu⁃min,and total protein were maintained in the treatment group(P>0.05).Self-Rating Anxiety Scale(SAS)and the Self-Rating De⁃pression Scale(SDS)scores before surgery did not differ between the two groups(P>0.05).At 7 days after surgery,SAS and SDS scores decreased in both groups and were significantly lower in the treatment group than in the control group(P<0.05).The incidence of nausea and vomiting,abdominal pain and distension,diarrhea,wound infection,pulmonary infection,abdominal infec⁃tion,and bowel routine did not differ between the two groups(P>0.05).Conclusion Early enteral nutrition support combined with routine nursing can improve nutritional status and negative emotions,lower incidences of adverse events,and wound infec⁃tions in patients receiving preventive ileostomy closure for low rectal cancer.