不同起始浓度肠内营养液在胃癌根治术后肠内营养中的应用效果

Effect of different initial concentrations of enteral nutrition solution on enteral nutrition after radical gastrectomy for gastric cancer

目的:探讨不同起始浓度肠内营养液在胃癌根治术后肠内营养应用中的效果。方法:选取行胃癌根治术后应用早期肠内营养(EEN)的患者为研究对象,根据纳入与排除标准及患者EEN浓度,最终纳入5%浓度组、10%浓度组、20%浓度组各30例。术中留置鼻肠管或空肠营养管,营养管管路末端均位于位置空肠上端。患者自术后第1天开始肠内营养(EN),EN制剂采用整蛋白型EN制剂(能全素)。5%、10%、20%浓度组分别给予浓度5%、10%、20%的能全素营养液,起始速度为30 ml/h,并根据胃肠道反应及时调整输注速度、正常大小。观察肠内营养提供机体所需50%目标能量的过渡时间,患者每天肠内营养输注克数及完成情况,观察首次排气时间、排便时间及胃肠道并发症。结果:(1)不同肠内营养提供机体所需50%目标能量的过渡时间比较,差异有统计学意义(P=0.000)。(2)不同浓度肠内营养患者术后第1天肠内营养输注速度及输注时间比较,差异有统计学意义(P均=0.00)。患者术后第2天肠内营养输注克数及速度比较,差异有统计学意义(P=0.00)。(3)不同起始浓度患者观察患者首次排气时间、排便时间比较,差异无统计学意义(P>0.05)。(4)不同起始浓度患者营养过程中第1天、第2天胃肠道不良反应比较,差异有统计学意义(P<0.05)。不同起始浓度患者营养过程中第3天、第4天、第5天胃肠道不良反应比较,差异无统计学意义(P>0.05)。结论:胃癌根治术后早期肠内营养支持阶段,建议以5%EN液为起始速度,每天将输注浓度在原基础上增加5%,以首次喂养量为12.5 g(57.75 kCal),起始输注速度20~30 ml/h为宜,并根据患者个体化情况及时调整。

Objective To investigate the effect of different concentrations of enteral nutrition in the transitional stage of early enteral nutrition support after radical gastric cancer surgery.Method The patients who received early enteral nutrition after radical gastrectomy were selected as research object. Retrospectively select the patients who applied early enteral nutrition after radical gastrectomy in our department from January 2015 to December 2020. According to the inclusion and exclusion criteria, determine the concentration of early enteral nutrition in patients, and finally include 30 patients with 5%, 10% and 20% concentrations. Nasoenteric tube or jejunal nutrition tube was indwelling during operation, and the end of nutrition tube was located at the upper end of jejunum. The patient began enteral nutrition on the first day after operation, and the enteral nutrition was made of whole protein enteral nutrition. The 5%, 10% and 20% concentration groups were given 5%, 10% and 20% Nengquan nutrient solution with an initial speed of 30 ml/h, and the infusion speed and concentration were adjusted in time according to the gastrointestinal reactions of patients. Observe the transition time for enteral nutrition to provide 50% of the target energy required by the body, the number of grams of enteral nutrition infusion per day and the completion of enteral nutrition infusion, the first exhaust and defecation time of patients, and gastrointestinal complications.Results(1)There was a statistically significant difference in the transition time of different enteral nutrition to provide 50% of the target energy required by the body(P=0.000).(2)There were statistically significant differences in the speed and time of enteral nutrition infusion on the first day after the operation of enteral nutrition patients with different concentrations(P=0.00). There was a statistically significant difference in the grams and speed of enteral nutrition infusion on the second postoperative day(P=0.00).(3)There was no statistically significant difference in the time of first gas and defecation in patients with different initial concentrations(P>0.05).(4)There was a statistically significant difference in gastrointestinal irregularities on the 1 st and 2 nd day of the nutritional process of patients with different initial concentrations(P<0.05). There was no statistically significant difference in gastrointestinal non-reaction in patients with different initial concentrations on the 3 rd, 4 th, and 5 th days of the nutritional process during good nutrition(P>0.05). Conclusion In the transitional stage of early enteral nutrition support after radical gastric cancer, it is recommended to start with 5% enteral nutrient solution, increase the daily infusion concentration by 5% from the original basis, and set the first feeding amount to 12.5 g(57.75 kCal), and the initial infusion The speed is 20~30 ml/h, and it should be adjusted in time according to the individual situation of the patient.