胃次全切除术后早期肠内营养对胃肠动力的影响

Effect of early enteral nutrition on gastrointestinal motility after subtotal gastrectomy

目的 观察胃次全切除术后早期给予肠内营养对胃肠动力的影响。方法 将 1999年 12月至 2 0 0 1年 2月接受手术治疗的进展期胃癌患者共 18例随机分成肠内营养组和对照组各 9例 ,分别给予术后早期肠内营养和普通治疗。应用SynecticsMicroDigitrapper动态测压仪及配套的Polygram软件记录、分析、比较两组术后胃肠动力波形的变化 ,记录术后并发症等情况。结果 胃切除术后早期所有患者的移行性复合运动 (MMC)均消失 ,术后第一个MMC出现的时间为 34min～ 4h不等 ,两组相比差异无显著性。术后早期MMC的表现与正常MMC有明显不同 :缺乏MMCⅡ相 ,仅由Ⅰ相和Ⅲ相构成 ;72h内MMC的周期变异逐步趋于一致。观察期内偶见逆向传导的MMC。肠内营养组的MMCⅢ相持续时间 (TIME)、曲线下面积 (AREA)、传导速度 (V)、动力指数 (MI)四项指标均高于对照组 ,两组比较差异有显著性。两组的术后并发症比较差异无显著性。结论 胃次全切除术后早期实施肠内营养可加速MMC的传导 ,改善MMC的收缩活动 ,促进胃肠动力的恢复。

Objective To observe the influence of early postoperative enteral feeding on gastrointestinal motility after subtotal gastrectomy. Methods From December 1999 to February 2001,18 patients with advanced gastric cancer who had underwent gastrectomy were randomly allocated into enteral nutrition(EN) group ( n =9) and control group( n =9). The migrating motor complex (MMC) was recorded by Synectics MicroDigitrapper antroduodenal manometry and data was analyzed by Polygram software. Results MMC disappeared after subtotal gastrectomy in all patients,the first MMC recurred from 34 mins to 4 hours after the operation,while there was no significant difference between two groups. However,MMC in EN group was different from those in normal group which was lack of phase -Ⅱ at the early postoperative stage,the variation of MMC trended to become normal during 72 hours of consecutive observation. Compared with control group,the duration of MMC-phase-Ⅲ,area under the curve,transmit speed and motility index were different in EN group. Conclusion Early postoperative enteral feeding can help re-build the normal gastrointestinal motility .Further studies about patients' selections and nutrition preparations are needed.