加速康复外科理念下胃癌患者术后早期肠内营养不耐受的危险因素分析

Risk factors of early postoperative enteral nutritional intolerance in patients with gastric cancer under the concept of enhanced recovery after surgery

目的探讨加速康复外科(ERAS)理念下胃癌患者术后早期肠内营养(EEN)不耐受的危险因素。方法回顾性分析2018年1月至2022年8月在巴彦淖尔市医院胃肠外科接受胃癌根治术及术后EEN治疗的135例患者的临床资料,使用肠内营养耐受性评分表评估患者肠内营养耐受情况,将评分<5分定义为EEN耐受组(n=65),评分≥5分定义为EEN不耐受组(n=70)。对比分析两组患者临床资料。采用logistic向后逐步回归法进行多因素分析。结果两组术前美国麻醉医师协会(ASA)分级、手术时间、术中出血量、EEN开始时间、营养液类型及术后并发症发生情况比较,差异均有统计学意义(P<0.10)。多因素logistic回归分析结果显示,ASA≥Ⅳ级、手术时间>4 h、术后发生并发症为胃癌术后发生EEN不耐受的独立危险因素(OR=11.812、3.735、3.977,P<0.05)。结论ERAS理念下胃癌患者术后EEN不耐受的危险因素包括ASA≥Ⅳ级、手术时间>4 h、术后并发症,对具备上述风险因素的患者进行个体化营养支持有助于提高肠内营养耐受率,减少相关并发症的发生。

Objective To investigate the risk factors of early enteral nutrition(EEN)intolerance in gastric cancer patients after surgery under the concept of enhanced recovery after surgery(ERAS).Methods The research was a retrospective case-control study.The clinicopathological data of 135 patients who underwent radical and postoperative EEN for gastric cancer in the Department of Gastrointestinal Surgery at Bayannur Hospital between January 2018 to August 2022 were retrospectively analyzed.Enteral nutrition tolerance rating scale was used to evaluate the patients′enteral nutrition tolerance.The score<5 were defined as the EEN tolerance group(n=65),score≥5 were defined as the EEN intolerance group(n=70).The clinicopathological data of the patients in the two groups were compared.Logistic backward stepwise regression was used to conduct multivariate analysis.Results There were statistically significant differences between the two groups in preoperative American Society of Anesthesiologists(ASA)classification,operative time,intraoperative bleeding,time of EEN initiation,type of nutrient solution,and occurrence of postoperative complications(P<0.10).Multivariate logistic regression analysis showed that ASA classification≥Ⅳ,operative time>4 h,and occurrence of postoperative complications were independent risk factors for the occurrence of EEN intolerance after gastric cancer surgery(OR=11.812,3.735,3.977,P<0.05).Conclusion Risk factors for postoperative EEN intolerance in gastric cancer patients under the ERAS concept include ASA classification≥Ⅳ,operative time>4 h,and postoperative complications,and individualized nutritional support for patients with these risk factors can help to improve the tolerance rate of enteral nutrition and reduce the occurrence of related complications.