围术期肠内营养在腹腔镜胃癌根治术中的应用

目的探讨快速康复模式下围手术期序贯肠内营养在腹腔镜胃癌手术患者中的应用价值。方法从2013年7月至2015年7月将入选的115例拟行腹腔镜胃癌根治手术的患者随机分为实验组和对照组。实验组患者采用快速康复模式下的围手术期准备+序贯性肠内营养支持,对照组采用传统术前准备+传统静脉营养支持,其中实验组55例,对照组60例。数据处理使用SPSS 19.0软件,两组患者术前术后营养指标、免疫功能指标、肠道菌群变化等用均数±标准差表示,组间比较采用独立样本t检验,同一组不同时间前后比较采用配对t检验;术后并发症采用卡方检验比较组间差别。P0.05差异有统计学意义。结果营养指标:术前肠内营养支持的实验组前白蛋白水平高于实验组,差异有统计学意义(P0.05),术后第5天,实验组患者的白蛋白、前白蛋白水平均较术前明显增加,白蛋白明显高于对照组差异有统计学意义(P0.05)。免疫学指标:术后第5天实验组与对照组的CRP水平及WBC水平均显著下降,且实验组下降幅度大于对照组,差异具有统计学意义(均P0.05)。实验组Ig A水平在术后第3、第5天时较对照组同期水平增高、组间差异有显著性(P0.05)。肠道菌群变化:术后两组患者益生菌:双歧杆菌、乳酸杆菌计数较术前明显减少(P0.05);而致病菌:大肠杆菌、葡萄球菌等的计数则较术前明显增高(P0.05)。临床观察结果:实验组肛门排气排便时间、首次进食流质时间及术后住院时间均比对照组提前。两组间比较差异有统计学意义(P0.05)。术后并发症两组均无吻合口漏等严重并发症,差异无统计学意义(P0.05)。结论快速康复模式下围手术期序贯肠内营养支持能改善患者的营养情况,调节机体的炎症免疫反应,增强肠道的黏膜屏障功能,减少肠道菌群失调,降低术后并发症发生,加速患者康复。

Application of perioperative sequential enteral nutrition in patients undergoing laparoscopic radical gastrectomy

Objective To investigate the clinical value of perioperative sequential enteral nutrition in patients undergoing laparoscopic gastrectomy for gastric cancer in ERAS model.Methods From July 2013 to July 2015,115 patients undergoing laparoscopic radical gastrectomy were randomly divided into experimental group and control group.Patients in experimental group were treated with ERAS and sequential enteral nutrition,while the control group received traditional preoperative preparation and traditional intravenous nutritional support.Clinical data were analyzed by using statistical software SPSS 19.0.Measurement data such as perioperative nutrition index,immune function,intestinal microflora changes were expressed as mean ± standard deviation (x ± s),and were examined by using t test.Count data,such as postoperative complication rate,were expressed as ％,and were examined by using x2 test.A P value ＜0.05 was considered as statistically significant difference.Results Nutritional parameters:in experimental group,after preoperative enteral nutrition support,albumin levels were significantly increased (P ＜ 0.05).On 5 days after surgery,albumin and pre-albumin levels were obviously increased in patients of experimental group,which were better than those in control group,with significant differences (P ＜ 0.05).Immunological parameters:CRP and WBC levels were significantly decreased in experimental group and control group on 5 days after surgery,especially in experimental group (P ＜ 0.05).The level of IgA in the experimental group was higher than that of the control group on days 3 and day 5 after surgery,with significant difference (P ＜ 0.05).The changes of intestinal flora after operation in two groups:probiotic Bifidobacterium,Lactobacillus count decreased significantly compared with the preoperative (P ＜ 0.05).Pathogenic bacteria:Escherichia coli,Staphylococcus aureus,count is higher than that before surgery (P ＜0.05).Clinical observation results:the experimental group anal exhaust and defecation time,for the first time eating liquid time and postoperative hospital stay were earlier than those in control group,with significant difference between the two groups (P ＜ 0.05).There were no serious complications such as anastomotic leakage in both groups,however infection complications occurred (including respiratory tract infection,urinary tract infection,wound infection,intestinal infection,systemic inflammatory response syndrome),especially in control group,without significant difference (P ＞ 0.05).Conclusion ERAS with enteral nutrition support could improve nutritional status of patients under inflammatory conditions,modulate immune response,enhance intestinal mucosal barrier function,reduce intestinal flora,reduce incidence of postoperative complications,and promote the rehabilitation of patients.