消化道肿瘤术后早期肠内营养支持的临床疗效评估

目的探讨消化道肿瘤术后早期肠内营养支持的临床疗效评估。方法选取消化道肿瘤手术的156例病人，随机分为肠外营养（parenteral nutrition，PN）组76例和肠内营养（enteral nutrition，EN）组80例。两组都接受术后营养支持，热量相当。比较两组手术前和术后8天的体质量、体质量指数（body mass index，BMI）、血清总蛋白（total protein，TP）、白蛋白（albumin，ALB）、前白蛋白（prealbumin，PA）等指标变化情况以及胃肠道功能和手术并发症的发生率。结果术后8天，PN组病人体质量和BMI较术前均有下降，具有统计学意义（P〈0．05或P〈0．01）；EN组BMI上升，具有统计学意义（P〈0．01），与PN组比较具有统计学差异（P〈0．01）；两组病人均由负氮平衡转为正氮平衡，EN组上升数值优于PN组，组间比较具有统计学意义（t=1．71，P=0．044）；两组TP均下降，但EN组TP下降较PN组幅度小，组间比较具有统计学意义（t=2．16，P=0．016）；EN组ALB出和PA术后上升数值大于PN组，但差异无统计学意义（P〉0．05）。肛门排气时间EN组比PN组早，具有统计学意义（P〈0．01）；EN组肺部感染率较PN组低，具有统计学意义（P〈0．05）。结论对消化道肿瘤术后患者给予早期EN支持，相比PN可以更有效的改善患者营养状况、减少手术后并发症。

Clinical Treatment Effect Evaluation of Early Postoperative Enteral Nutrition Support in Patients with Digestive Tract Cancer

Objective To study the feasibility and efficacy of early postoperative enteral nutrition support in patients with digestive tract cancer. Methods A total of 156 patients after operation for digestive tract cancer were selected and randomly divided into parenteral nutrition （PN） group （76 cases） and enteral nutrition （EN） group （80 cases）. Both groups accepted postoperative nutrition support with equal amount of heat. The body weight （BW）, body mass index （BMI）, serum total protein （TP）, albumin （ALB） and prealbumin （PA） were detected before and after operation. The gastrointestinal function recovery state and lhe occurrence rate of the complications was observed. Results Eight days after operation, BW and BMI in PN group were significantly decreased （P〈0. 05 or 0. 01） ; BMI in EN group was increased （P〈0. 01 ） and significantly different compared with that in PN group （P〈0. 01） ; the negative nitrogen balance turned to positive nitrogen balance in both two groups, and the increased index in EN group was better （P〈0. 01）; TP decreased in both groups and the decrease in EN group was lower （P〈0.01） ; the increase of ALB and PA in EN group was higher than that in the PN group without statistical significance （P〈0. 05）. Recovery time of intestinal function was obviously earlier, and surgical wound infection and lung infection rate was lower in EN group （P〈0. 01 or 0. 05）. Conclusion Ear ly postoperative EN in the patients with digestive tract cancer can more effecitvely promote gastrointestinal function recovery and improve nutritional metabolism than PN.