围术期营养支持治疗对重度营养不良结直肠癌患者的护理效果及预后研究

Nursing Effect and Prognosis of Perioperative Nutritional Support Therapy for Severe Malnutrition Patients with Colorectal Cancer

目的探讨围术期营养支持治疗对重度营养不良结直肠癌患者的临床应用效果。方法选择2015年6月—2018年12月我院收治的重度营养不良结直肠癌患者127例,随机分为重点护理组64例和一般护理组63例。一般护理组采用传统模式进行营养支持,重点护理组采用围术期肠内营养支持治疗,比较两组患者术后恢复、营养水平、并发症和生存情况。结果与一般护理组相比,重点护理组患者首次排气时间[(62.43±8.36)d vs.(70.37±10.47)d]、首次排便时间[(4.02±1.01)d vs.(5.69±1.26)d]、住院时间[(9.35±2.18)d vs.(12.76±3.19)d]、胃管留置时间[(2.68±1.42)d vs.(4.51±2.83)d]、术后进食时间[(9.77±2.56)h vs.(43.69±6.31)h]均明显缩短(P<0.05);术后7 d的转铁蛋白[(1.92±0.23)g·L^(-1)vs.(1.74±0.27)g·L^(-1)]、血清白蛋白[(37.94±4.51)g·L^(-1)vs.(31.17±3.62)g·L^(-1)]、前白蛋白[(0.32±0.06)g·L^(-1)vs.(0.26±0.05)g·L^(-1)]水平均明显升高(P<0.05);术后发生切口感染(3.13%vs.14.28%)、肺部感染(3.13%vs.12.70%)和泌尿系统感染(3.13%vs.12.70%)的比例均明显下降(P<0.05);3年累积生存率(81.3%vs.69.8%)明显提高(P<0.05)。结论围手术期肠内营养支持能够加快重度营养不良结直肠癌患者术后肠道功能的恢复,改善营养水平,降低并发症,提高患者生存率。

Objective To analyze the effects of perioperative nutritional support therapy on patients with severe malnourished colorectal cancer.Methods A total of 127 patients with severe malnourished colorectal cancer treated in our hospital between June 2015 and December 2018 were randomly divided into two groups,intensive care group(n=64)and general care group(n=63).Patients in general care group got traditional nutritional support therapy,while those in intensive care group got perioperative enteral nutritional support.The postoperative recovery,nutritional level,complications and survival indicators of patients were analyzed and compared between the two groups.Results The intensive care group had significantly shorter first exhaust time[(62.43±8.36)d vs.(70.37±10.47)d]than the general care group,as well as shorter first defecation time[(4.02±1.01)d vs.(5.69±1.26)d],hospitalization time[(9.35±2.18)d vs.(12.76±3.19)d],gastric tube indwelling time[(2.68±1.42)d vs.(4.51±2.83)d]and postoperative feeding time[(9.77±2.56)h vs.(43.69±6.31)h](all P<0.05).Compared with the general care group,the intensive care group had the levels of transferrin[(1.92±0.23)g·L^(-1)vs.(1.74±0.27)g·L^(-1)],serum albumin[(37.94±4.51)g·L^(-1)vs.(31.17±3.62)g·L^(-1)]and prealbumin[(0.32±0.06)g·L^(-1)vs.(0.26±0.05)g·L^(-1)]increased significantly at 7 days after operation.The incidence rates of postoperative incision infection(3.13%vs.14.28%),pulmonary infection(3.13%vs.12.70%)and urinary tract infection(3.13%vs.12.70%)were significantly reduced in the intensive care group(P<0.05).The intensive care group also had higher 3-year cumulative survival rate than the general care group(81.3%vs.69.8%)(P<0.05).Conclusion For colorectal cancer patients with severe malnutrition,enhanced enteral nutrition support during perioperative period can promote the recovery of their postoperative intestinal function,reduce complications and improve their quality of life.