早期肠内营养在食管癌术后的临床应用研究

Clinical application of early enteral nutrition in postoperative esophageal cancer

目的:探讨早期肠内营养对食管癌根治术后病人营养状况及恢复情况的影响。方法:选取2017年1月至2022年4月施行食管癌根治术,术后24h内出现肠内营养不耐受的病人95例,依据是否继续接受肠内营养分为观察组(继续肠内营养组)41例和对照组(转为全肠外营养组)54例。以年龄、性别、肠内营养不耐受症状和级别为自变量,使用1:1最近邻法的倾向性得分,匹配出观察组和对照组病人各39例。比较匹配后两组病人各项指标的差异。结果:匹配后的两组病人在基线资料、术前营养状况及炎性因子等方面比较无统计学差异(P>0.05)。营养状况:术后1 d白蛋白水平较术前无显著统计学差异,两组间比较无统计学差异(P>0.05)。术后5 d、9 d两组病人白蛋白均呈上升趋势,其中观察组上升幅度较对照组快,有统计学差异(P<0.05)。炎性因子:2组病人术后1d的CRP均明显升高,与术前相比有统计学差异(P<0.05)。术后5 d时,2组病人CRP均呈下降趋势(P<0.05),观察组较对照组下降明显,有统计学差异(P<0.05)。术后9 d时2组病人CRP继续呈下降趋势(P<0.05),其中观察组下降幅度较快,与对照组比较有统计学差异(P<0.05)。并发症方面:2组病人在吻合口瘘、肺部感染、切口感染等感染性并发症的发生有统计学差异(P<0.05)。此外,观察组的术后首次排气/排便时间早于对照组,2组比较有显著性差异(P<0.05),但观察组的住院总费用、住院总时间与对照组相比无明显差异(P>0.05)。结论:食管癌术后Ⅰ-Ⅱ级肠内营养不耐受病人经积极干预后仍可继续行早期肠内营养治疗,早期肠内营养有助于改善病人的营养状况、降低炎症反应,减少术后并发症。

Objective:To investigate the effects of early enteral nutrition on the nutritional status and recovery of patients after radical resection of esophageal cancer.Methods:A total of 95 patients undergoing radical esophagectomy for esophageal cancer from January 2017 to April 2022 who developed enteral nutrition intolerance within 24 hours after surgery were selected and divided into observation group(continued enteral nutrition group,n=41)and control group(total parenteral nutrition group,n=54)according to whether they continued to receive enteral nutrition.With age,gender,symptoms and grade of enteral nutritional intolerance as independent variables,39 patients in the observation group and control group were matched by 1:1 nearest neighbor method of propensity score matching(PSM).Differences in various indicators between the two groups of patients after PSM were compared.Results:There were no significant differences in baseline data,preoperative nutritional status,and inflammatory factors between the two groups after PSM(P>0.05).As for nutritional status,there was no significant statistical difference in albumin levels at day 1 after surgery compared to those before surgery,and there was no statistical difference between the two groups(P>0.05).After 5d and 9d postoperatively,the albumin values of the two groups showed an upward trend,and the increase rate of the observation group was faster than that of the control group,with statistical difference(P<0.05).The CRP level in 2 groups was significantly increased at day 1 after surgery,with statistical difference compared with that preoperatively(P<0.05).At 5 days after surgery,CRP value in both groups showed a downward trend(P<0.05),and CRP value of the observation group was significantly lower than that of the control group,with statistical difference(P<0.05).At 9d after surgery,CRP in the 2 groups continued to decline(P<0.05),and the decreased rate in the observation group was faster,with statistical difference compared with that in the control group(P<0.05).There were statistical differences between the two groups in the incidence of anastomotic fistula,pulmonary infection,surgical site infection,and other infectious complications(P<0.05).In addition,the first postoperative exhaust/defecation time in the observation group was earlier than that in the control group,and there was a significant difference between the two groups(P<0.05),but the total hospitalization cost and length of stay in the observation group had no significant difference compared with those in the control group(P>0.05).Conclusion:Patients with Grade Ⅰ-Ⅱ enteral nutrition intolerance after esophageal cancer surgery can continue to receive early enteral nutrition therapy after active intervention.Early enteral nutrition is helpful to improve the nutritional status of patients,reduce inflammatory response,and reduce postoperative complications.