胃癌术后应用肠内营养制剂的对比研究

Comparative study of enteral nutrition in gastric cancer after operation

目的:本研究拟比较不同类型肠内营养(EN)制剂对胃癌术后病人营养状态和耐受性的影响。方法:收集2017年11月到2021年2月安徽医科大学第一附属医院普通外科(高新院区胃肠外科二病区)胃癌术后予以EN病人的术前、术后实施EN前(EN前)、实施EN后(EN后)的血液指标(包括总蛋白、白蛋白、前白蛋白、血红蛋白)及禁食水时间、腹腔引流管拔管时间、EN使用时间、EN起始时间、术后住院时间和EN费用。比较三组营养指标和耐受性的差异性。结果:共纳入符合标准病人125例,短肽组百普力(SP)28例、整蛋白能全力组(TPF)26例和整蛋白瑞素组(TP)71例。125例病人术前、实施EN前、实施EN后病人总蛋白、白蛋白、前白蛋白、血红蛋白结果有统计学差异(P<0.05);三组病人EN费用具有统计学差异(P<0.05);三组病人术前、EN前、EN后总蛋白、白蛋白、前白蛋白、血红蛋白结果及禁食时间、腹腔引流管拔管时间、EN使用时间、EN距术后间隔时间、术后住院时间无统计学差异(P>0.05)。耐受性比较显示SP耐受性较好。EN费用由高到低分别是SP、TPF和TP。结论:SP、TPF、TP EN制剂可改善胃癌术后病人的营养状况。术后早期可选择短肽类EN制剂。当病人术后肛门恢复排气,肠道消化吸收功能正常,可选用整蛋白制剂TP或TPF。TPF营养成分更为全面,而TP较TPF价格低。如病人经济条件允许,此时应选用TPF。

Objective:To compare the effects of different types of enteral nutrition(EN)on nutritional status and tolerance of patients with gastric cancer after operation.Methods:The data of those patients who were diagnosed gastric cancer that admitted to Gastrointestinal Surgery Department of the First Affiliated Hospital of Anhui Medical University from November 2017 to February 2021 were collected.Blood indicators(total protein,albumin,prealbumin,hemoglobin)before operation,before EN,after EN,fasting time,abdominal cavity drainage extubation time,EN start time,EN use time,postoperative hospital stay and cost were analyzed.Results:A total of 125 patients were enrolled who were divided into SP(28 cases)group,TPF(26 cases)group,and TP(71 cases)group.The results of total protein,albumin,prealbumin and hemoglobin were statistically different before and after enteral nutrition(P<0.05).Additionally,the enteral nutrition cost of the three groups was statistically different(P<0.05).There were no significant fifferences in the results of total protein,albumin,albumin and hemoglobin before and after enteral nutrition,fasting time,abdominal cavity drainage extubation time,EN start time,EN use time,postoperative hospital stay among the three groups(P>0.05).The tolerance of SP was the best in three groups.The cost of enteral nutrition from high to low was SP,TPF and TP,respectively.Conclusion:SP,TPF and TP can improve the nutritional status of postoperative patients with gastric cancer after operation.Short peptide enteral nutrition should be selected in the early phase after operation.TP or TPF can be used when anal exhaust is restored and intestinal digestion and absorption function is normal.TPF is more comprehensive in nutrition,while TP is cheaper than TPF.If the patient’s economic conditions allows,TPF should be used at this time.