肠内营养联合参麦注射液静脉滴注对胃癌患者术后疲劳综合征的影响

目的 探讨肠内营养联合参麦注射液静脉滴注对胃癌患者术后疲劳综合征（postoperative fatigue syndrome,POFS）的疗效.方法 将39例胃癌患者随机分为肠内营养组（EN组,n=19）和肠内营养联合参麦注射液静脉滴注组（SE组,n=20）,两组患者术后第2～8天均给予等氮、等热量的肠内营养支持.SE组在肠内营养支持的同时,予静脉滴注参麦注射液50ml/d,共用7d.评估患者术后疲劳程度,并检测血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）、肱三头肌皮褶厚度（TSH）、握力、IL-6、TNF-α、PGE2.结果 与EN组比较,SE组患者手术后的住院时间缩短,首次下床活动时间提前,差异统计学意义（P〈0.05）.SE组的VAS评分在术后第7、9天、术后累计疲劳评分及术后差值均低于EN组,差异有统计学意义（P〈0.05）,而两组间术后第1、3、5天的VAS评分的比较均无统计学差异（P〉O.05）;术后第9天,SE组的握力及其术后差值、前白蛋白水平及其术后差值均高于EN组,差异有统计学意义（P〈0.05）,而两组间血清总蛋白、白蛋白和肱三头肌皮褶厚度的比较无统计学差异（P〉0.05）;SE组的血清IL-6浓度在术后第9天低于EN组,差异有统计学意义（P〈0.05）,两组TNF-α、PGE2比较无统计学差异（P〉0.05）.结论 胃癌患者术后早期行肠内营养联合参麦注射液治疗是安全且有效的;它可能通过促进肌力的恢复,改善机体的营养状态,下调炎症反应水平,从而减轻术后疲劳程度.

Enteral nutrition combined with Shenmai injection improves postoperative fatigue syndrome in patients with stomach cancer

Objective To evaluate the effect of enteral nutrition combined with Shenmai injection on postoperative fatigue syndrome in patients with stomach cancer. Methods Thirty-nine patients with stomach cancer were randomly divided into enteral nutrition group （EN, n=19） and enteral nutrition combined with Shenmai injection group （SE, n=20）. Two group received iso ni- trogenous, iso caloric nutritional support form POD （postoperative day） 2 to POD8. And at same time, group SE received Shenmai injection 50ml/d. Postoperative hospital stay （PHS）, the first time of ambulation （FTA） and anal exsufflation （AE） were recorded. The visual analog scale （VAS）, total protein, albumin, prealbumin, triceps skin fold thickness, grip strength; IL-6,TNF-α and PGE2 were measured. Results The PHS was shorter and FTA was earlier in group SE than those in group EN （P〈 0.05）. VAS （at POD7, POD9）, VAS （POD9-POD1）, and postoperative accumulative fatigue score were lower in group SE than those in group EN （P〈 0.05）,but no significant difference at POD1,POD3,POD5 （P〉 0.05）. At POD9 and （POD9-POD1）, grip strength in group SE were stronger than that of group EN （P〈 0.05）, prealbumin levels and prealbumin （POD9-POD1） were higher in group SE than those in group EN （P〈 0.05）, but there were no difference at POD1, POD5 And at POD9, IL-6 concentration were lower in group SE than in group EN （P〈 0.05）. However, there were no significant differences in AE, total protein, albumin, triceps skin fold thickness, TNF-α and PGE2 between the wo groups （P〉 0.05）. Conclusion The study shows that early postoperative administration of enteral nutrition combined with Shenmai injection after radical gastrectomy for gastric cancer is safe and effective in reducing postoperative fatigue, possibly through promoting muscle recovery, improving nutrition, reducing inflammation.