Effect of Sequential Early Enteral Nutrition on Postoperative Rehabilitation and Complications in Gastric Cancer Patients

Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were randomly selected and divided into two groups:Group A(68 cases,receiving early enteral nutrition)and Group B(71 cases,receiving sequential early enteral nutrition),using computer randomization.The effects of the interventions on both groups were compared.Results:Seven days post-operation,the levels of nutritional indicators in Group B were significantly higher than those in Group A(P<0.05).Group B showed significantly better levels of inflammatory factors and immune factors compared to Group A seven days post-operation(P<0.05).The postoperative complication rate in Group B was 4.23%,2 significantly lower than that in Group A,which was 16.18%(χ=5.477,P=0.019).Conclusion:The utilization of sequential early enteral nutrition in gastric cancer patients after surgery demonstrated notable improvements in nutritional status and inflammation markers,along with enhanced immunity,effectively reducing postoperative complications.

Enhanced recovery after surgery-based nursing in older patients with postoperative intestinal obstruction after gastric cancer surgery:A retrospective study

BACKGROUND Gastric cancer-related morbidity and mortality rates are high in China.Patients who have undergone gastric cancer surgery should receive six cycles of chemotherapy according to their condition.During this period,intestinal obstruction is likely to occur.Electrolyte balance disorders,peritonitis,intestinal necrosis,and even hypovolemic shock and septic shock can seriously affect the physical and mental recovery of patients and threaten their health and quality of life(QoL).AIM To quantitatively explore the effects of enhanced recovery after surgery(ERAS)-based nursing on anxiety,depression,and QoL of elderly patients with postoperative intestinal obstruction after gastric cancer.METHODS The clinical data of 129 older patients with intestinal obstruction after gastric cancer surgery who were treated and cared for in our hospital between January 2019 and December 2021 were examined retrospectively.Nine patients dropped out because of transfer,relocation,or death.According to the order of admissions,the patients were categorized into either a comparison group or an observation group according to the random number table,with 60 cases in each group.RESULTS After nursing care,the observation group required significantly less time to eat for the first time,recover bowel sounds,pass gas,and defecate than the comparison group(P<0.05).No significant difference was noted in nutrition-related indicators between the two groups before care.Before care,the Symptom Check List-90 scores between the two groups were comparable,whereas anxiety,depression,paranoia,fear,hostility,obsession,somatization,interpersonal sensitivity,and psychotic scores were significantly lower in the observation group after care(P<0.05).The QoL scores between the two groups before care did not differ significantly.After care,the physical,social,physiological,and emotional function scores;mental health score;vitality score;and general health score were significantly higher in the observation group,whereas the somatic pain score was significantly lower in the observation group(P<0.05).CONCLUSION ERAS-based nursing combined with conventional nursing interventions can effectively improve patient’s QoL,negative emotions,and nutritional status;accelerate the time to first ventilation;and promote intestinal function recovery in elderly patients with postoperative intestinal obstruction after gastric cancer surgery.

Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction

Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with many advantages.This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.Methods:According to the methods of preoperative nutrition therapy,143 patients were divided into EN group(n=42)and PN group(n=101)between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital.Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage.The generalized additive model and twopiecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.Results:EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO,which is a protective factor,especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy(>3 d)did not accelerate the postoperative recovery of gastrointestinal functions.Conclusions:Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery.For patients with absolute obstruction,no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.

Difference in the effects of three nutritional pathways on postoperative rehabilitation in patients with gastric cancer and type 2 diabetes mellitus

Objective To explore the difference in the effects of three nutritional pathways on the rehabilitation of patients with gastric cancer and diabetes mellitus after operation.Methods Overall,120 patients were randomly divided into the partial parenteral nutrition(PPN),early enteral nutrition(EEN),and diabetes mellitus special enteral nutritional emulsion(DEN)groups.The differences in the effects of three nutritional modes were compared.Results(1)On postoperative day four,the total protein level in the EEN and DEN groups was significantly higher than that in the PPN group(P<0.05).On postoperative day ten,body mass index,lymphocyte count,total protein level,and pre-albumin level in the DEN group were significantly higher than those in the PPN group(P<0.05).(2)On postoperative day four,there was no significant difference in the fasting blood glucose level between the EEN and DEN groups(P>0.05),but this level was significantly lower than that in the PPN group(P<0.05).On postoperative day ten,fasting and postprandial blood glucose levels in the DEN group were significantly lower than those in the PPN group.(3)On postoperative day four,the C-reactive protein level in the DEN group was significantly lower than that in the other groups(P<0.05).(4)The incidence rates of complications in the PPN,EEN,and DEN groups were 25.0%,10.0%,and 5.0%,respectively.The incidence of complications in the PPN group was significantly higher than that in the other groups.However,there was no significant difference in perioperative indexes among the three groups(P>0.05).Conclusion Enteral nutrition is more conducive to the recovery of patients with gastric cancer and type 2 diabetes mellitus after operation;the special enteral nutrition emulsion for diabetes mellitus is more effective than the conventional nutrition solution in stabilizing blood sugar levels and reducing the degree of inflammation.

Effect of Sijunzi decoction combined with nutritional support after gastric cancer surgery on the stress inflammatory response and immune response

Objective:To study the effect of Sijunzi decoction combined with nutritional support after gastric cancer operation on the stress inflammatory response and immune response.Methods:Patients who received radical operation for gastric cancer in West China Hospital between March 2015 and August 2017 were selected and randomly divided into the observation group who accepted Sijunzi decoction combined with enteral nutrition support after operation and the control group who accepted routine enteral nutrition support after operation. The stress inflammatory response indexes in serum and the immune response indexes in peripheral blood were measured before operation and 3 d after operation.Results: 3 d after operation, Cor, Gluc, Ins, O2-, CRP, TNF-α, YKL-40, MK and IL-6 contents in serum as well as GATA-3, RORγt and Foxp3 expression in peripheral blood of both groups were higher than those before operation whereas HO-1 and SOD contents in serum as well as CD3+CD4+T cell, CD3+CD8+T cell, CD16+CD56+NK cell and CD19+B cell contents and T-bet expression in peripheral blood were lower than those before operation, and Cor, Gluc, Ins, O2-, CRP, TNF-α, YKL-40, MK and IL-6 contents in serum as well as GATA-3, RORγt and Foxp3 expression in peripheral blood of observation group were lower than those of control group whereas HO-1 and SOD contents in serum as well as CD3+CD4+T cell, CD3+CD8+T cell, CD16+CD56+NK cell and CD19+B cell contents and T-bet expression in peripheral blood were higher than those of control group.Conclusion: Sijunzi decoction combined with nutritional support after gastric cancer operation can reduce the stress inflammatory response and enhance the immune response.

Short-term effects of supplementary feeding with enteral nutrition via jejunostomy catheter on post-gastrectomy gastric cancer patients

Background Most gastric cancer patients who undergo gastrectomy develop malnutrition. It is, therefore, crucial to establish an effective means to provide nutrition for these patients. To perform home enteral nutrition （EN） to ensure adequate nutritional intake in gastric cancer patients, we placed a jejunostomy catheter during gastric surgery. Most patients showed improved nutritional status. Methods Twenty-nine inpatients at our hospital underwent radical gastrectomy and jejunostomy from December 2002 to December 2007 and were designated as the jejunostomy group, and 32 matched patients without a jejunostomy tube were designated as the tube-free group. The jejunostomy group was treated with EN from 72 hours to 3 months postoperatively. The tube-free group did not receive EN. Data including preoperative and postoperative body weight, body mass index （BMI）, nutrition risk screening （NRS） score, Karnofsky performance score （KPS）, and laboratory biochemical indicators were documented respectively and compared. Results Compared with preoperative week 1, both groups showed decreased body weight and BMI at 3 months postoperatively. The weight loss in the jejunostomy group （（7.1±3.3） kg） was significantly less than that in the tube-free group （（9.9±3.1） kg）. Similarly, BMI decreased by （2.4±1.0） kg/m2 in the jejunostomy group, which was significantly less than in the tube-free group （（3.2±0.9） kg/m2）. The number of patients with postoperative NRS 〉3 was decreased in the jejunostomy group, but was increased in the tube-free group, and this difference was significant. There were no significant differences between the two groups in total lymphocyte count, hemoglobin, albumin and prealbumin, and adverse drug effects. Conclusions Short-term （3 months） EN supplementation via jejunostomy tube can reduce the risk of malnutrition and weight loss, and improve tolerance of chemotherapy. Tube feeding is reliable for achieving these goals because it is not important whether or not the oatients have appetites.

耳穴揿针对改善胃癌根治术后患者胃肠功能及营养状况的效果

目的探讨耳穴揿针对胃癌根治术后患者胃肠功能及营养状况的影响。方法选取2021年6月—2022年3月江苏省中医院接受胃癌根治术的68例患者为研究对象,按照组间基本特征具有可比性的原则分为观察组与对照组,每组34例。对照组患者予以常规护理,观察组患者在此基础上接受耳穴揿针疗法,两组患者干预3天,对比其胃肠功能恢复情况、术后第3天的胃肠道不良反应、术后第7天的机体营养状况。结果观察组患者术后肠鸣音恢复时间、首次排便时间短于对照组,组间比较差异有统计学意义(P<0.05);两组患者术后首次排气时间比较差异无统计学意义(P>0.05)。观察组患者术后第3天腹胀、恶心呕吐发生率低于对照组,组间比较差异有统计学意义(P<0.05)。术前1 d,两组患者的血清总蛋白(TP)、前白蛋白(PA)比较差异无统计学意义(P>0.05);术后7 d,两组TP水平比较差异无统计学意义(P>0.05),但观察组患者PA水平高于对照组,组间比较差异有统计学意义(P<0.05)。结论耳穴揿针可以促进胃癌术后患者肠鸣音恢复,缩短首次排便时间,有效降低胃癌根治术后患者恶心、呕吐及腹胀的胃肠道不良反应发生率,提高术后患者机体营养水平,从而提升生活质量,促进术后康复。

营养支持链式管理在胃癌围术期患者中的应用

目的探讨围术期营养支持链式管理对胃癌患者术后营养状况及营养知信行水平的影响。方法将胃癌患者162例按住院时间分为对照组82例(2021年6—12月入院)、干预组80例(2022年1—6月入院)。对照组实施常规围术期营养管理,干预组实施营养支持链式管理,术后1个月比较2组患者的营养状况及营养知识知信行水平。结果干预组术后1个月总蛋白<60 g/L占比为5.00%,低于对照组的14.63%;干预组术后1个月白蛋白<35 g/L占比为3.75%,低于对照组的13.41%;干预组术后1个月体质量指数(BMI)正常范围者占比83.75%,高于对照组的59.75%,差异有统计学意义(P<0.05)。干预组术后1个月营养知识、支持态度、支持行为维度得分以及营养知信行总分均高于对照组,差异有统计学意义(P<0.05)。结论围术期实施营养支持链式管理能有效增加患者营养摄取量,改善胃癌患者术后营养状况,提升患者营养知信行水平和生活质量。

基于预后营养指数的分级营养护理在行化学治疗胃癌患者中的应用

目的探析基于预后营养指数(PNI)的分级营养护理在行化学治疗(简称“化疗”)胃癌患者中的实施效果和价值。方法回顾分析2020年10月至2022年3月于福建省肿瘤医院接受化疗的胃癌患者的临床资料,共筛选出80例患者。其中,实施常规护理的41例患者为对照组,应用基于PNI的分级营养护理的39例患者为观察组。比较2组的营养指标、免疫功能以及不良反应。结果干预1个月及3个月后,2组的PNI均比干预前升高,血清总蛋白、白蛋白、前白蛋白和血红蛋白水平,以及免疫球蛋白A、免疫球蛋白G和免疫球蛋白M水平均比干预前降低(P均<0.05);观察组的PNI、上述营养指标和免疫指标水平均较同期对照组更高(P均<0.05)。观察组的不良反应(如白细胞减少、口腔黏膜炎等)总发生率较对照组更低(P<0.05)。结论在行化疗的胃癌患者中实施基于PNI的分级营养护理,能够有效改善营养状况和免疫功能,并降低不良反应发生率。

循证护理对食管癌术后早期肠内营养支持的作用分析

目的:分析循证护理对食管癌术后早期肠内营养支持效果的影响。方法:将2021年1月—2023年6月于滨州医学院附属医院进行治疗的74例食管癌术后早期肠内营养支持患者随机分为对照组(37例,常规护理)和观察组(37例,常规护理联合循证护理)。对比两组术后胃肠动力恢复指标、术后管道留置时间、住院时间、并发症发生率、血清学指标。结果:与对照组相比,观察组术后肛门排气时间、排便时间、进食流质食物时间均较短(P<0.05);与对照组相比,观察组术后胃管、胸腔引流管、腹腔引流管留置时间及住院时间均较短(P<0.05);观察组并发症发生率低于对照组(P=0.017);术后1周,两组血清白蛋白、总蛋白水平升高,观察组高于对照组(P<0.05)。结论:食管癌患者术后早期肠内支持期间通过应用循证护理有助于减少相关并发症,加快患者术后康复以及改善机体营养状况。

胃癌患者围术期营养管理方案的构建

目的构建胃癌患者围术期营养管理方案,为临床营养管理实践提供参考。方法采用循证方法检索文献并提取最佳证据,结合9名临床专家经验访谈,形成胃癌患者围术期营养管理方案初稿。采用德尔菲法对15名专家进行专家函询。结果2轮专家函询有效回收率均为100%,专家权威程度分别为0.92、0.95,总体肯德尔和谐系数分别为0.205、0.218(均P<0.05)。最终形成包含营养管理模式、营养风险筛查和评估、术前营养干预、术后营养干预、营养支持监测与护理、出院宣教6项一级指标,16项二级指标,42项三级指标的营养管理方案。结论胃癌患者围术期营养管理方案涵盖围术期营养管理全过程,具有较好的可靠性和实用性,可进一步开展临床验证研究。

基于授权理论的饮食护理对胃癌化疗患者营养状况、生活质量的影响

目的评估授权理论在胃癌化疗患者饮食护理中的营养状况与生活质量的影响。方法通过便利抽样方式,选取2023年4月至2024年3月在郑州大学第一附属医院消化内科接受化疗的胃癌患者90例,根据患者初次入院时的病区分配,将其分为对照组和研究组,每组45例。研究组接受基于授权理论的饮食护理方案,而对照组接受传统的饮食护理,评估指标包括患者的营养依从性、营养支持状况、营养不良发生情况、外周血营养指标及生活质量评分等。结果研究组的饮食依从性(91.11%)、营养支持达标率(86.67%)均高于对照组(55.56%、37.78%)(χ^(2)=14.556,P=0.001;χ^(2)=22.878,P<0.001)。研究组的营养不良发生情况(15.56%)低于对照组(51.11%)(χ^(2)=17.566,P=0.001)。研究组总蛋白、血清前白蛋白、白蛋白水平均高于对照组(t=28.296,P<0.001;t=5.238,P<0.001;t=17.174,P<0.001)。研究组总体健康状况、社会功能、角色功能、认知功能、情绪功能和躯体功能评分均高于对照组(t=7.706,P<0.001;t=5.263,P<0.001;t=9.069,P<0.001;t=7.793,P<0.001;t=5.580,P<0.001;t=10.040,P<0.001);研究组恶心/呕吐、疲劳、失眠、腹泻、便秘和食欲不振评分均低于对照组(t=9.047,P<0.001;t=5.089,P<0.001;t=4.232,P<0.001;t=6.560,P<0.001;t=5.047,P<0.001;t=11.892,P<0.001)。结论采用基于授权理论的饮食护理模式,能有效提升胃癌化疗患者的营养状态和生活质量,减轻治疗相关不良反应。

大承气汤加减联合肠内营养支持对胃癌根治术后患者胃肠功能、免疫功能及营养状况的影响

目的探讨大承气汤加减联合肠内营养支持对胃癌根治术后患者胃肠功能、免疫功能及营养状况的影响。方法回顾性分析2020年6月—2022年6月该院接诊的62例胃癌根治术患者的诊疗情况,按治疗方法不同分为观察组和对照组各31例。对照组患者采取肠内营养治疗,观察组在此基础上给予大承气汤加减治疗,两组均接受1周的连续治疗。比较两组患者的术后排便时间、肛门排气时间、肠鸣音恢复时间、首次进食时间,治疗1周后,比较两组患者治疗前后T淋巴细胞亚群水平(CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8))、免疫球蛋白[免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白M(immunoglobulin M,IgM)]、营养指标[血红蛋白(hemoglobin,Hb)、前白蛋白(prealbumin,PAB)、人血清白蛋白(human serum albumin,HSA)、转铁蛋白(transferrin,TRF)]的水平变化及并发症情况。结果治疗后,观察组在排便时间、肛门排气时间、肠鸣音恢复时间、首次进食时间均明显短于对照组(P<0.05);治疗后,观察组CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8)、IgA、IgG、IgM、Hb、PAB、HSA、TRF水平均明显高于对照组(P<0.05);治疗期间,观察组的并发症发生率明显低于对照组(P<0.05)。结论大承气汤加减联合肠内营养支持能有效改善胃癌根治术后患者胃肠功能、免疫功能,促进营养状况的恢复,值得在临床中进行推广。

食管癌患者术后家庭肠内营养管理的最佳证据总结

目的检索食管癌术后患者家庭肠内营养(home enteral nutrition,HEN)管理的相关证据进行评价并整合,为临床制定HEN管理提供循证证据。方法检索UpToDate、澳大利亚循证护理和保健研究中心(Joanna Briggs Institute,JBI)、苏格兰院际间指南网、医脉通、欧洲临床营养与代谢学会网站、Cochrane Library、PubMed、知网、万方等数据库中关于食管癌术后HEN管理的指南、专家共识、系统评价、证据总结、随机对照试验、最佳实践,检索时限为建库至2023年7月31日,由2名研究者独立完成文献质量的评价、证据提取及整合。结果共纳入13篇文献,包括6篇指南,2篇专家共识,2篇系统评价,3篇随机对照研究。共总结出24条最佳证据,包括组建家庭营养支持团队、营养筛查与评估、制定HEN治疗方案、健康宣教、监测评价及随访5个方面。结论本研究总结了食管癌术后患者HEN管理的相关证据,可为临床食管癌术后患者HEN管理提供借鉴和参考,建议结合具体临床情境及利益相关者的意愿有针对性地选择应用证据。

赋能教育联合肠内营养剂对胃癌化疗患者营养状况的影响

目的探讨赋能教育联合肠内营养剂对胃癌化疗患者营养状况的影响。方法随机抽取福建医科大学肿瘤临床医院2022年2月—2023年2月收治的100例胃癌化疗患者作为研究对象。按照护理方法不同将患者分为试验组与对照组,各50例。2组采用常规胃癌化疗,对照组给予胃癌患者肠内营养剂辅助,试验组采用赋能教育联合肠内营养剂的方法。比较2组血清蛋白水平、营养状况、不良反应发生情况、生活质量评价。结果护理后,试验组总蛋白、白蛋白、前白蛋白、血红蛋白及体质量分别为(74.82±4.21)g/L、(46.82±3.71)g/L、(4.31±0.71)g/L、(128.81±10.41)g/L、(72.12±12.17)kg,均高于对照组的(70.89±4.91)g/L、(42.91±5.10)g/L、(3.54±0.68)g/L、(122.84±8.31)g/L、(65.94±9.08)kg(P<0.05)。护理后,试验组患者主观整体评估(patient-generated subjective global assessment,PG-SGA)评分为(1.55±0.41)分,低于对照组的(3.22±0.75)分(P<0.05)。试验组不良反应总发生率为4.00%,低于对照组的26.00%(P<0.05)。护理后,试验组生活质量评分低于对照组(P<0.05)。结论胃癌化疗患者给予赋能教育联合肠内营养剂干预,能够改善血清蛋白及营养水平,提高生活质量的同时能够减少不良反应。

头颈癌放疗患者家庭肠内营养支持管理的最佳证据总结

目的总结头颈癌放疗患者家庭肠内营养管理的最佳证据,为临床决策和管理提供循证依据。方法检索国内外数据库及网站中自建库至2023年12月关于头颈癌放疗患者家庭肠内营养的临床决策、指南、证据总结、专家共识、系统评价、随机对照试验等,对各类研究进行文献质量评价后提取证据。结果共纳入17篇文献,总结包括家庭肠内营养的评估与启动、家庭肠内营养的实施、患者自我管理、组织管理、营养监测与随访5个方面共30条证据。结论总结的头颈癌放疗患者家庭肠内营养最佳证据,可为开展家庭肠内营养实践提供指引。

中医特色护理技术结合ERAS理念对腹腔镜下胃癌根治术患者胃肠功能恢复的影响

目的:观察中医特色护理技术结合加速康复外科(ERAS)理念对腹腔镜下胃癌根治术患者胃肠功能恢复的影响。方法:选择腹腔镜下胃癌根治术患者86例,按照中医特色护理技术实施时间,将2022年1月—2022年9月实施ERAS理念护理的42例患者设为对照组,2022年10月—2023年6月实施中医特色护理技术结合ERAS理念护理的44例患者设为中医组;比较2组胃肠功能恢复时间、术后住院时间、术后疼痛程度[视觉模拟评分法(VAS)]、营养风险[营养风险筛查法(NRS-2002)评分]、并发症发生情况以及护理满意度。结果:中医组肛门首次排气时间、首次排便时间、肠鸣音恢复时间、术后住院时间均短于对照组,差异有统计学意义(P<0.05)。术后1 d、2 d、3 d,中医组VAS评分均低于对照组(P<0.05),术后7 d,2组VAS评分比较,差异无统计学意义(P>0.05)。治疗后,2组NRS-2002评分均较治疗前升高(P<0.05),中医组NRS-2002评分低于对照组(P<0.05)。中医组并发症发生率为9.09%,对照组为26.19%,2组比较,差异有统计学意义(P<0.05)。中医组护理满意度为93.18%,对照组为76.19%,2组比较,差异有统计学意义(P<0.05)。结论:中医特色护理技术结合ERAS理念可促进腹腔镜下胃癌根治术患者康复,缩短胃肠功能恢复和术后住院时间,有效降低营养风险及并发病发生率,提高护理满意度。

术前肠内免疫营养治疗对结直肠癌术后病人临床疗效和安全性影响的Meta分析及GRADE评价

目的:系统评价术前肠内免疫营养对结直肠癌病人的疗效,以期为临床营养治疗提供参考依据。方法:计算机检索PubMed、Web of Science、EMbase、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang Database)、维普数据库(VIP)中关于结直肠癌病人接受术前肠内免疫营养的随机对照试验(RCT)。检索时限均为建库至2023年4月7日。由2位评审人员依据纳入及排除标准分别筛选文献、提取数据及质量评价,采用RevMan 5.4软件进行Meta分析。结果:共纳入16篇文献,涉及1462例病人。Meta分析结果显示,两组CD8^(+)水平、非感染性并发症发生率比较,差异无统计学意义(P均>0.05)。相较于对照组,试验组可提高IgA水平[MD=0.47,95%CI(0.16,0.79),P=0.003]、IgG水平[MD=2.03,95%CI(1.34,2.71),P<0.0001]、IgM水平[MD=0.24,95%CI(0.09,0.39),P=0.001]、CD4^(+)水平[MD=2.81,95%CI(2.19,3.44),P<0.0001]、CD4^(+)/CD8^(+)水平[MD=0.15,95%CI(0.10,0.20),P<0.00001]、血红蛋白水平[MD=9.11,95%CI(0.74,17.49),P=0.03]、血清清蛋白水平[MD=2.27,95%CI(0.92,3.61),P=0.001]及前清蛋白水平[MD=52.35,95%CI(15.21,89.50),P=0.006],可降低感染性并发症总发生率[RR=0.46,95%CI(0.28,0.73),P=0.001]、切口感染发生率[RR=0.60,95%CI(0.40,0.89),P=0.01]及肺部感染发生率[RR=0.38,95%CI(0.16,0.88),P=0.02]。GRADE系统评价结果显示,证据质量水平IgG、CD4^(+)/CD8^(+)、感染并发症总发生率、切口感染发生率、肺部感染发生率、非感染性并发症发生率为中级,IgA、IgM、CD4^(+)、CD8^(+)、血清清蛋白为低级,血红蛋白、前清蛋白为极低级。结论:现有证据表明,结直肠癌术后病人应用术前肠内免疫营养可有效提高病人体液免疫功能、细胞免疫功能,改善营养状况,降低感染性并发症发生率。

胃癌病人围术期营养管理方案的构建

目的:构建胃癌病人围术期营养管理方案。方法:组建研究团队,通过文献循证形成胃癌病人围术期营养管理方案初稿,采用德尔菲函询对15名相关专科领域专家进行专家咨询,进一步修改、完善,形成胃癌病人围术期营养管理方案。结果:共进行2轮专家咨询,2轮咨询专家问卷回收率分别为88.24%和100.00%,2轮专家权威系数分别为0.827和0.833,2轮肯德尔和谐系数分别为0.178和0.180(均P<0.001)。最终形成包含胃癌病人营养管理模式、胃癌病人术前营养干预、胃癌病人术后营养干预、营养支持的监测与护理、出院后营养指导5个一级指标、12个二级指标、31个三级指标的胃癌病人围术期营养管理方案。结论:构建的胃癌病人围术期营养管理方案具有一定的科学性、可靠性、实用性。

肺癌术后肠内营养患者胃潴留影响因素分析

目的探讨肺癌术后肠内营养患者胃潴留的影响因素。方法选取医院2022年1月至2023年11月行手术治疗并配合肠内营养支持的肺癌患者60例,对其胃潴留的发生情况进行监测,分析胃潴留影响因素。结果患者平均置管时间为(12.83±6.22)d。共发生胃潴留5例(8.33%),其中置管10 d内4例,10 d后1例;胃潴留的独立危险因素包括肠鸣音减弱、高血糖、便秘、低血钾、机械通气等。结论肺癌术后肠内营养患者胃潴留的风险较高;独立危险因素包括肠鸣音减弱、高血糖、便秘、低血钾、机械通气等,需针对性开展护理。