进食路径管理对胃癌根治术后患者加速康复的效果观察

Effect of eating pathway management on accelerated recovery of patients after radical gastrectomy for gastric cancer

目的 探讨进食路径管理对胃癌根治术患者加速康复的效果。方法 选择2019年1-8月四川省肿瘤医院胃肠外科收治的151例患者为对照组,依据胃癌术后加速康复外科中国专家共识指导患者第1天可进清流质饮食,第2天可进半流食,然后逐渐过渡至正常饮食。选择2020年1-8月本科室收治的138例患者为观察组,术后根据加速康复理念,对患者进行进食路径管理,制订胃癌根治术后进食路径表及出院后的饮食指导手册,指导并协助患者落实每天每次的具体食物种类和量。比较两组患者术后营养指标、并发症发生率、胃肠功能恢复时间、饮食种类、进食量、睡眠质量。结果 两组患者出院时、出院后1个月、出院后3个月、出院后6个月时的血红蛋白、血清白蛋白、前白蛋白水平比较结果显示,两组4个时点各指标均呈逐渐升高的趋势,时间之间差异有统计学意义(P时间<0.05);出院时、出院后1个月、出院后3个月、出院后6个月时各指标均以观察组高于对照组,差异有统计学意义(P组间<0.05),并且随观察时间延长,组间差异逐渐增大,组间随时间变化的差异有统计学意义(P交互<0.05)。观察组并发症发生率低于对照组,饮食种类多于对照组,进食量高于对照组,胃肠功能恢复时间早于对照组,睡眠质量高于对照组,组间差异均有统计学意义(P<0.05)。结论 胃癌根治术后的进食路径表有助于患者快速康复,降低并发症发生率,提高睡眠质量。

Objective To explore the effect of eating pathway management on accelerated recovery of patients underwent radical gastrectomy for gastric cancer. Methods 151 patients admitted in the gastrointestinal surgery department of Sichuan Cancer Hospital from January to August 2019 were selected as the control group. According to the consensus of Chinese experts on accelerated rehabilitation surgery for gastric cancer, the patients were instructed to take clear fluid diet on the first day, semi-liquid diet on the second day, and then gradually transition to normal diet. 138 patients admitted in the department from January to August 2020 were selected as the observation group. According to the concept of accelerated recovery after surgery, the patients were managed by eating pathway, and the eating pathway table after radical gastritis and the dietary guidance manual after discharge were formulated to guide and assist the patients to implement the specific types and quantities of food every day. Postoperative nutritional indicators, incidence of complications, recovery time of gastrointestinal function, types of diet, food intake and sleep quality were compared between the two groups. Results At discharge, 1 month after discharge, 3 months after discharge and 6 months after discharge, the levels of hemoglobin, serum albumin and prealbumin in the two groups showed a trend of gradually increase at 4 time points between the two groups,the differences was statistically significant(P<0.05). At discharge, 1 month after discharge, 3 months after discharge and 6 months after discharge, all indexes in the observation group were higher than the control group, the differences were statistically significant(P<0.05). As the observation time extended, the differences between groups gradually increased, and the differences between groups over time were statistically significant(P<0.05). The incidence of complications in the observation group was lower than that in the control group, the types of diet were much more than the control group, the amount of food intake was higher than the control group, the recovery time of gastrointestinal function was earlier than the control group, and the sleep quality was higher than the control group, the differences were statistically significant(P<0.05). Conclusion Eating pathway table after radical gastrectomy could help patients recover quickly, reduce the incidence of complications and improve sleep quality.