营养途径对食管癌围术期患者营养状况的影响

Effects of different nutritional approaches on the nutritional status of patients with esophageal cancer during perioperative period

目的探讨肠内营养与肠外营养对食管癌围术期患者的营养状况和并发症的影响。方法回顾性分析淮安市第二人民医院2017年1月至2018年6月食管癌手术治疗患者73例,根据营养干预途径不同分为全肠外营养组(TPN)23例和全肠内营养组(TEN)50例。TPN组给予静脉营养治疗,TEN组给予经鼻饲管(经鼻至空肠起始位置)肠内营养治疗。比较两组患者营养指标和免疫指标、术后肠道功能和安全性指标。结果两组患者就诊前后体重丢失、入院时血清白蛋白、淋巴细胞数组间比较,差异无统计学意义(P>0.05)。TPN组血清白蛋白和淋巴细胞数不同时间点整体比较,差异均具有统计学意义(P<0.05)。TEN组淋巴细胞数不同时间点整体比较,差异均具有统计学意义(P<0.05)。两组手术后组间比较,TEN组体重丢失幅度小于TPN组;TEN组术后72h、术后120h血清白蛋白均短于TPN组,TEN组术后120h淋巴细胞数高于TPN组;TEN组肛门排气时间和肠鸣音恢复时间均低于TPN组,差异均具有统计学意义(P<0.05)。两组不良反应和不良事件比较,差异无统计学意义(P>0.05)。结论对食管癌围术期患者而言,肠内营养的疗效总体优于肠外营养,且安全性无明显差异。

Objective To explore the effects of enteral nutrition and parenteral nutrition on the nutritional status and complications of patients with esophageal cancer during perioperative period Methods 73 patients with esophageal cancer during perioperative period treated in the Second People's Hospital of Huai'an from January 2017 to June 2018 were retrospectively analyzed.They were divided into 23 cases in total parenteral nutrition(TPN)group and 50 cases in total enteral nutrition(TEN)group according to different ways of nutrition intervention.The TPN group was given intravenous nutritional,and the TEN group was given enteral nutritional via a nasal feeding tube(through the nose to the beginning of the jejunum).The nutritional and immune indexes,postoperative intestinal function and safety indexes in the two groups were compared.Results There was no significant difference in the weight loss,serum albumin and lymphocyte group between the two groups of patients on admission(P>0.05).The comparison of serum albumin and lymphocyte counts in the TPN group,and the comparison of lymphocytes in the TEN group at different time points showed statistically significant differences(P<0.05).The weight loss of TEN group was lower than that of TPN group,and the difference was statistically significant;Serum albumin at 72h and 120h after the surgery in the TEN group was lower than that in the TPN group,the lymphocytes at 120h after the surgery in the TEN group were higher than that in the TPN group,and the differences were statistically significant(P<0.05);The recovery time of anal exhaustion and bowel sounds in the TEN group were shorter than those in the TPN group,and the differences were statistically significant(P<0.05).There was no significant difference in safety between the two groups(P>0.05).Conclusion For perioperative patients with esophageal cancer,total enteral nutrition is generally better than total parenteral nutrition,but total parenteral nutrition can quickly increase serum albumin levels.