结肠癌患者术后肠内肠外营养辅助化疗的合理性和安全性研究

目的 探讨结肠癌患者经手术治疗后增加肠内肠外营养辅助化疗的合理性和安全性.方法 随机选取2011年6月-2013年2月在我院行结肠癌手术治疗的患者99例,随机分为3组：肠外营养组（TPN）、肠内营养组（TEN）和肠内外联合营养组（TPN＋ TEN）,每组各33例,观察3组患者手术前后体质量（BM）、上臂肌围（MAMC）、三头肌皮褶厚度（TSF）、血浆白蛋白（Alb）及血红蛋白（Hb）水平、氮平衡情况、胃肠道功能变化和并发症等.结果 各组患者经过营养支持后,BM、MAMC、TSF、血浆Alb及Hb等与治疗前比较差异无统计学意义（P＞0.05）;3组患者术后负氮平衡逐日改善,与术后第1天相比,差异有显著统计学意义（P＜0.01）.组间比较术后第2-7天的氮平衡及累计氮平衡,TEN与TPN及TPN＋TEN差异均有显著统计学意义（P＜0.01）,TPN与TPN＋TEN比较差异无统计学意义（P＞0.05）.3组患者并发症发生情况无明显差异,肠道恢复时间TEN最快,组间比较差异有显著统计学意义（P＜0.01）.结论 肠内和肠外营养辅助支持治疗在结肠癌患者术后化疗期间均存在一定的优势与劣势,在临床应用中要做到合理运用,提高其支持有效率,降低并发症的发生率.

Rationality and Safety Analysis of Postoperative Enteral and Parenteral Nutrition in Adjuvant Chemotherapy for Patients with Colorectal Cancer

Objective To study the rationality and safety of postoperative enteral and parenteral nutrition in adjuvant chemotherapy for patients with eoloreetal cancer （CRC）. Methods A total of 99 CRC patients underwent CRC surgery in our hospital from June 2011 to February 2013 were divided into 3 groups：total parenternal nutrition （TPN） group,total enternal nutrition （TEN） group and combination group （TPN＋TEN）,33 cases for each. Body mass （BM）, mid-arm muscle circumference （MAMC）, triceps skinfold thickness （TSF）, levels of plasma albumin （Alb） and hemoglobin （Hb）,nitrogen balance condition,gastrointestinal function changes and complications in 3 groups were observed. Results After nutritional support,there were no significant differences in BM, MAMC, TSF, Atb and Hb when compared with treatment before （P〈0.05）. Compared with postoperative 1 d, negative nitrogen balance improved evidently （P〈0. 01 ）, which had significant difference between TEN and TPN groups with combination group during postoperative 2-7 d respectively （P〈0.01）, but the difference between TEN and TPN groups was not significant （P〈0. 05）. There were no significant differences between 3 groups in complications, however, the recovery time of intestinal function was the shortest in TEN group, and the differences were significant between groups （P〈0.01）. Conclusion Enternal and parenteral nutritional support in adjuvant chemotherapy both have advantages and disadvantages, whole rational utilization in clinic could effectively improve supportive efficacy and reduce complication rate.