高龄胃癌患者术后早期营养支持方案的对比研究

目的探讨高龄胃癌患者术后早期实施营养支持的合理方案.方法在胃癌切除术后第1天将60例高龄进展期胃癌患者随机分为全肠内营养(TEN组,n=18)、肠内 肠外营养(EN PN组,n=23)、全肠外营养(TPN组,n=19)3组,分别予以相应的营养支持治疗,并在营养支持前、后测定营养指标与血清胃泌素水平,观察其胃肠道功能恢复情况及各种不良反应并作比较.结果3组病例在研究期间无严重并发症,血浆白蛋白、前白蛋白和转铁蛋白水平营养支持后均明显升高(P＜0.05).临床观察TEN组、EN PN组肛门恢复排气时间较TPN组明显缩短,胃泌素水平明显升高(P＜0.05),EN PN组胃肠道相关并发症少于TEN组(P＜0.05).结论高龄胃癌患者术后仍应首选EN,但不应刻意追求TEN,联合应用EN与PN并适时调整,可减少胃肠道相关并发症.

Clinical studies on early post-operative nutritional support for elderly patient with gastric cancer

Objective To explore more reasonable way of early post-operative nutritional support for elderly patient of gastric cancer. Methods 60 cases of advanced gastric cancer were randomly divided into TEN group(n=18), EN+PN group(n=23) and TPN group(n=19). Parameters including the body weight, the renal and liver functions, and serum gastrin were measured before and after nutritional support. The complications, vital signs and resumption of gastrointestinal function were carefully observed. Results No mortality and serious morbidity occurred in all the groups. The levels of serum albumin, Prealbumin and transferrin were significantly elevated after nutritional support in the three groups(P<0.05).The bowel movement resumed earlier and serum gastrin increased significantly both in the EN+PN and TEN groups than in the TPN groups. Conclusion Early post-operative EN for elderly patients of gastric cancer is the first choice but EN+PN is superior to TPN or TEN in terms of decreasing gastrointestinal complications.