三种不同肠内营养支持方案对胃癌胃切除病人预后影响的比较

目的比较三种不同肠内营养支持方案对胃癌胃切除病人临床结局的影响。方法纳入90例术前营养风险筛查无风险的胃癌胃切除病人,围术期分别接受三种不同肠内营养支持方案,回顾性分析三种方案的营养支持效果、不良反应,以及术后住院时长、术后并发症发生率等指标。将90例病人分为A、B、C三组,A组(肠道预适应组):术前常规进食+术前口服、术后管饲整肠内营养混悬液整蛋白-中链三酰甘油(TP-MCT)];B组(整蛋白组):术前常规进食、术后管饲肠内营养混悬液(TP-MCT);C组(短肽组):术前常规进食、术后管饲肠内营养混悬液短肽(SP)]。比较三组病人术前及术后第1、7天营养指标(白蛋白、总白蛋白、前白蛋白);术前及术后第7天人体测量指标:体重、体质量指数、上臂围、三头肌皮褶厚度、上臂肌围,人体成分指标以及术前及术后第1、3、7天胰岛素抵抗指标(血糖、血清胰岛素、胰岛素敏感指数)。同时观察比较三组并发症的发生情况、术后肠功能恢复时间、恢复流质饮食时间、耐受经口进食时间、术后住院时长。结果三组病人术后营养相关指标、胰岛素抵抗指标,以及术后住院时长差异均无统计学意义(均P>0.05)。A组术后腹胀例数显著低于B组(P<0.05),与C组差异无统计学意义(P>0.05),C组腹胀例数与B组间差异无统计学意义(P>0.05);A组术后感染例数显著低于B组(P<0.05),C组感染例数与B组间差异无统计学意义(P>0.05);A组与C组术后胃瘫例数显著低于B组(P<0.05),A组与C组间差异无统计学意义;A组与C组术后恢复经口进食时间显著早于C组(P<0.05),A组与C组间差异无统计学意义。结论三种营养支持方案在改善术后营养状况以及住院时长方面差异无统计学意义。对于术前无营养风险的病人,术前3 d常规口服肠内营养混悬液(TP-MCT)行肠道预适应,能够减少术后腹胀等不良反应的发生,降低感染、胃瘫的发生率,尽早恢复病人经口进食,提高了病人术后使用肠内营养的依从性,有利于病人术后恢复。术前无肠道预适应病人,术后使用短肽型营养剂在不良反应、并发症的发生方面优于使用肠内营养混悬液(TP-MCT)。

Comparison of the effects of three different enteral nutrition schemes on the prognosis of patients undergoing radical gastrectomy for gastric cancer

Objective To compare the effects of three different enteral nutrition schemes on the prognosis of patients undergoing radical gastrectomy for gastric cancer.Methods Ninety patients with gastric cancer undergoing gastrectomy who were not at risk for preoperative nutritional risk screening were enrolled and received three different nutritional support regimens.The nutritional support effect,adverse reactions,postoperative hospital stay,incidence of postoperative complications and other indicators of the three regimens were retrospectively analyzed.group A(intestinal preconditioning group):preoperative routine eating+preoperative oral,postoperative tube feeding protein-type nutrition:nutrition mixtureintein-medium chain triacylglycerol(TP-MCT)];group B(intein group):preoperative routine eating,postoperative tube feeding nutrition mixture(TP-MCT);group C(short peptide group):preoperative routine eating,postoperative tube feeding short peptide nutrition:nutrition mixtureshort peptide(SP)].Nutritional parameters(albumin,total albumin,prealbumin)on postoperative days 1 and 7,anthropometric parameters body weight,body mass index(BMI),upper arm circumference(MAC),triceps skinfold thickness(TSF),upper arm muscle circumference(MAMC),body composition parameters,and insulin resistance parameters(blood glucose,serum insulin,insulin sensitivity index)on postoperative days 1,3,and 7 were compared among the three groups.The incidence of complications,postoperative recovery time of intestinal function,recovery time of liquid diet,tolerance time of eating,and postoperative hospital stay were also observed and compared among the three groups.Results There was no significant difference in postoperative nutrition-related indexes,insulin resistance indexes and postoperative hospital stay among the three groups(P>0.05).The number of cases of postoperative abdominal distension in the intestinal preconditioning group was significantly lower than that in the whole protein group(P<0.05),slightly lower than that in the short peptide group(P>0.05),and the number of cases of abdominal distension in the short peptide group was lower than that in the whole protein group,with no significant difference(P>0.05);the number of cases of postoperative infection in the intestinal preconditioning group was significantly lower than that in the whole protein group,with no significant difference(P>0.05);the number of cases of postoperative gastroparesis in the intestinal preconditioning group was significantly lower than that in the whole protein group(P<0.05),with no significant difference between the intestinal preconditioning group and the whole protein group.Conclusion There was no significant difference among the three nutritional support Schemes in improving postoperative nutritional status and length of hospital stay.For the patients without nutritional risk before operation,the routine oral administration of total protein enteral nutrition suspension(TP-MCT)for intestinal preconditioning 3 days before operation can reduce the incidence of adverse reactions of digestive tract such as abdominal distention,reduce the incidence of infection and gastroparesis,recover the patients′oral feeding as soon as possible,improve the compliance of patients with enteral nutrition after operation,and is conducive to the recovery of patients after operation.The short peptide nutrition was better than total protein enteral nutrition suspension(TP-MCT)in adverse reactions and complications for the patients without intestinal preconditioning before operation.