胃癌根治术患者术后肠内营养耐受状况及影响因素研究

Status and influencing factors of enteral nutrition tolerance in patients undergoing radical gastrectomy

目的 探讨胃癌根治术患者术后肠内营养(EN)耐受状况及其影响因素。方法 2021年1月至2023年12月选取南通市肿瘤医院1 347例实施胃癌根治术后EN喂养的住院患者作为研究对象,依据EN过程中是否发生胃肠道不适分为EN耐受组(499例)、EN不耐受组(848例)。调查胃癌根治术患者术后EN耐受现状,收集患者相关资料,分析影响其EN耐受的主要因素。结果 胃癌根治术患者EN不耐受发生率为62.95%(848/1 347);EN耐受率为37.05%(499/1 347),EN不耐受患者中发生腹泻41.98%(356/848)、腹胀36.79%(312/848)、胃潴留18.04%(153/848)、呕吐/反流3.18%(27/848)。多因素logistic回归分析显示,年龄(OR=2.519)、EN置管方式(鼻空肠管OR=0.643,造瘘OR=2.996)、术后首次下床活动时间(>4 h OR=0.567)、营养制剂种类(OR=3.705)、应用镇静/镇痛药物(OR=2.474)、初始EN输注方式(OR=3.434)是胃癌根治术患者术后EN耐受情况的独立影响因素。结论 胃癌根治术患者术后EN不耐受发生率较高,影响因素包括年龄、EN置管方式、术后首次下床活动时间等,临床应针对患者实际情况采取合适的EN喂养策略,最大程度减少喂养不耐受发生。

Objective To explore the status of enteral nutrition(EN)tolerance and its influencing factors in patients undergoing radical gastrectomy.Methods From January 2021 to December 2023,1347 inpatients who underwent radical gastrectomy and received EN at Nantong Tumor Hospital were selected for this study.They were divided into the EN tolerance group(499 cases)and the EN intolerance group(848 cases)based on whether gastrointestinal discomfort occurred during EN.The current status of EN tolerance in patients after radical gastrectomy was investigated,and relevant patient data were collected to analyze the main factors affecting their EN tolerance.Results The incidence of EN intolerance among patients who underwent radical gastrectomy was 62.95%(848/1347),while the EN tolerance rate was 37.05%(499/1347).Among the patients with EN intolerance,the incidence of diarrhea was 41.98%(356/848),abdominal distension was 36.79%(312/848),gastric retention was 18.04%(153/848),and vomiting/reflux was 3.18%(27/848).Multivariate Logistic regression analysis demonstrated that age(OR=2.519),EN catheterization method(nasal jejunal tube OR=0.643,fistula OR=2.996),the time of first postoperative mobilization(>4 h OR=0.567),the type of nutritional preparation(OR=3.705),the use of sedative/analgesic drugs(OR=2.474),and the initial EN infusion method(OR=3.434)were independent influencing factors on EN tolerance in patients after radical gastrectomy.Conclusions The incidence of EN intolerance after radical gastrectomy is relatively high,with factors such as age,EN catheterization method,and the time of first postoperative mobilization exerting an influence.Clinically,appropriate EN feeding strategies should be adopted based on the patient′s actual condition to minimize the occurrence of feeding intolerance.