老年胃癌全胃切除术后早期营养支持的临床研究

目的研究老年胃癌全胃切除术后早期肠内营养（EN）和肠外营养（PN）支持的效果。方法选择65岁以上接受胃癌手术的患者38例,术后随机分为PN组（n=20）和EN组（n=18）。检测营养支持前后营养指标、氮平衡,观察肠功能恢复情况、住院时间、营养支持费用、各种不良反应及术后并发症。结果术后2组患者之间的营养指标差异均无统计学意义（P〉0.05）,但2组组内营养指标如前白蛋白、血清白蛋白、转铁蛋白在营养支持后均显著升高（P〈0.05）;2组术后第8天营养支持后患者均由负氮平衡转为正氮平衡（P〈0.05）;EN组肛门排气、排便时间及住院时间均较PN组明显缩短（P〈0.05）,EN组营养支持费用较PN组降低（P〈0.05）。2组观察期间均无严重并发症。结论老年胃癌全胃切除术后给予EN比PN更有助于肠道功能的恢复,减少住院天数,较为经济。

A clinical study of early nutritional support following total gastrectomy in aged patients with gastric cancer

Objective To investigate the effect of early enteral nutritional（EN） and parenteral nutritional（PN） support following total gastrectomy in aged patients with gastric cancer.Methods 38 gastric cancer patients（aged≥65） undergoing total gastrectomy were selected and randomized into enteral nutrition（EN） group（n=18） and parenteral nutrition（PN） group（n=20）.Determinations of nutritive index and nitrogen balance were performed before and after nutritional support,as well as observation of the intestinal function recovery state,duration of hospitalization,nutritional support costs,various adverse reactions and the post-operative complications.Results The differences in the nutrition indicators between the two groups had no statistical significance（P 0.05）,while the nutritional indicators such as pre-albumin,albumin and transferrin at the end of nutrition support significantly increased in both groups（P0.05）.All patients in both groups changed from negative nitrogen balance into positive nitrogen balance at the end of 8-day nutritional support（P0.05）.The duration from the operation to the outset of flatus and defecation as well as duration of hospitalization were significantly shortened in EN group in comparison to PN group（P0.05）,and nutrition support costs in EN group were reduced as compared to PN group（P0.05）.No serious complications occurred in either of the groups.Conclusion Early EN regimen following gastrectomy in the aged patients with gastric cancer is more feasible than PN in the recovery of enteral functions,with reduced duration of hospitalization and expenditure.