肠内、肠外营养对胃大部切除术后患者胃肠激素及胃动力的影响--前瞻性随机对照研究

目的比较肠内与肠外营养方式对胃大部切除术后患者胃肠激素及胃动力的影响,探究预测手术后发生胃瘫的敏感指标.方法将41例限期行胃大部切除术患者,随机分为肠内营养组（EN组,20例）与肠外营养组（PN组,21例）,术后分别给予肠内营养或肠外营养支持治疗,于术前、术后第1、7天清晨分别测定患者血清胃泌素（GAS）、血浆胃动素（MTL）、血浆胆囊收缩素（CCK）水平,术前、术后第7天行空腹胃电图（EGG）检查,并连续记录术后胃液引流量.结果（1）胃肠激素：EN组患者术后第7天MTL、胆囊收缩素水平明显高于PN组（P＜0.01）;两组患者GAS水平无明显差别.（2）胃动力：EGG提示EN组术后第7天胃电节律恢复情况明显优于PN组.结论（1）胃大部切除术严重干扰胃肠激素分泌以及正常胃电节律,抑制了胃蠕动.（2）胃大部切除术后应用肠内营养较肠外营养更有益于患者胃肠激素水平及胃动力功能指标的恢复.（3）胃肠激素（GAS、MTL、CCK）和EGG尚不宜作为预测手术后胃瘫发生的敏感指标.

The effects of enteral nutrition vs parenteral nutrition on gastric motility and gastroenteric hormones after subtotal gastrectomy: a perspective randomized compared clinical trial

OBJECTIVE: To compare the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy. Try to find the possible prognosticating marks for the postoperative gastroparesis. METHODS: Forty-one patients after gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first day after operation (POD + 1) to the seventh day (POD + 7), patients received either EN (EN group) or PN (PN group) with isocaloric and isonitrogenous intake. Serum gastrin (GAS), plasma motilin (MTL) and plasma cholecystokinin (CCK) were measured on preoperative day, POD + 1 and POD + 7. Electrogastrography (EGG) was measured on preoperative day, and POD + 7. RESULTS: On the seventh day after gastrectomy, plasma MTL and CCK levels in EN group are higher than those in PN group. There is no difference in GAS between two groups. EGG in EN group is better than that in PN group postoperatively. CONCLUSIONS: The level of gastroenteric hormones and the gastric motility are decreased significantly after subtotal gastrectomy. In contrast with PN, EN could accelerate the recovery of some gastroenteric hormones and the gastric motility after subtotal gastrectomy. GAS, MTL, CCK and EGG are not accurate enough as the marks for prognosticating the postoperative gastroparesis.