胃癌术后出院患者家庭肠内营养使用情况分析

Analysis on the use of home enteral nutrition support in patients with postoperative gastric cancer

目的探讨胃癌术后患者营养情况、家庭肠内营养(HEN)使用情况及其现存问题。方法将124例胃癌根治术患者采用患者提供的主观整体营养状况评价量表(PG-SGA)在出院时及出院4周时进行营养评估,分析患者的HEN使用情况及存在问题。结果出院4周时,36.3%患者遵循术后少食多餐原则(进食次数≥6次/天),81.5%患者有胃肠道不适症状,25.0%患者有3种及以上胃肠道不适症状。出院4周时,患者体重、体重指数(BMI)均明显下降,淋巴细胞计数、血红蛋白、人血白蛋白均明显上升,差异均有统计学意义(P﹤0.01)。出院4周时,不同营养支持方式患者的能量摄入比较,差异有统计学意义(P﹤0.01)。22例出院后停用HEN的患者中,6例为出院时医师未开具医嘱,2例为留置空肠营养管路,14例为需要口服营养补充(ONS)支持,具体停用情况为9例因营养液口味不佳,8例因自觉无需使用,4例因住院期间出现胃肠道不适症状且无法耐受,1例因营养支持费用较贵无法负担。结论胃癌术后出院患者营养状况较差,应用HEN营养支持时间及能量摄入不理想,医护人员应加强对出院患者的营养教育和管理,定期随访并解答患者疑问,确保营养支持的有效性。

Objective To investigate the nutritional status,application of home enteral nutrition(HEN)support and current problems in patients with gastric cancer after surgery.Method A total of 124 patients undergoing radical gastrec-tomy for gastric cancer were evaluated by scored patient-generated subjective global assessment(PG-SGA)at discharge time and 4 weeks after discharge,the application of HEN and problems were evaluated.Result Four weeks after dis-charge,36.3%patients stuck to frequent smaller meals(food intake times≥6 times/d),81.5%patients experienced gastro enteral discomfort and 25.0%patients experienced more than 3 symptoms of gastro-enteral discomfort.The body weight and body mass index(BMI)decreased,but lymphocyte count,hemoglobin and albumin increased significantly 4 weeks after discharge(P<0.01).There was significant difference for energy intake in patients receiving different nutrition sup-port methods(P<0.01).In 22 discontinued cases of HEN,6 cases were not prescribed,2 cases chose jejunum nutrition tubes,14 cases needed ONS nutrition support,specifically,9 cases discontinued due to poor taste of nutritional prepara-tion,8 cases due to self-perception of non-necessity,4 cases due to intolerable gastro-enteral discomfort during admission and 1 case due to unaffordable nutritional support.Conclusion The patients’nutritional status are poor after 4 weeks of discharge,and the HEN nutritional time and energy intake are inadequate.The medical staff should strengthen nutrition education and management of patients during discharge with regular follow-up and response to patients’questions to en-sure the effectiveness of home enteral nutrition.