胃肠道术后早期不同途径肠内营养的应用

目的 :比较胃肠道术后早期经鼻肠管和空肠造口管二条途径进行肠内营养支持的方便性、优越性以及并发症。　方法 :选择胃肠道手术病人共 5 5例 ,按序随机分成A、B、C三组 ,A组为鼻肠管组 ,B组为空肠造口管组 ,C组为对照组。A、B二组应用肠内营养输注系统 ,在手术后 6h开始均匀输注能全力 ,分别记录术中鼻肠管和空肠造口管的放置时间、观察肠内营养支持期间的临床表现 ,并分别测定肠内营养支持前后病人的血常规、血糖、肝肾功能、电解质和营养指标以及术后并发症。　结果 :A组术中放置鼻肠管时间为 (2 9.2± 5 .6 )min ,B组术中经空肠穿刺放置Flocare可裂式空肠造口管时间为 (7.2± 2 .3)min ,二者比较差异非常显著 (P <0 .0 1)。术后肛门排气恢复时间A、B二组均比对照组快 (P <0 .0 1)。A组应用能全力后有 1例胃癌行根治术病人因腹痛、腹胀 ,不能耐受 ,中途停止使用 ;2例出现恶心、呕吐 ,经减慢输注速度后缓解 ;有 8例出现鼻咽部不适及 2例出现肺炎 ,经超声雾化、抗菌药物治疗后痊愈。B组 1例结肠癌行根治术病人因护理不当导致空肠造口管滑脱而中途停止使用 ;3例出现腹痛 ,经调整温度后缓解。所有病人没有出现腹泻、急性机械性肠梗阻、肠瘘和代谢性并发症。A组和B组应用能全力后 ,前白蛋白比对照组升高 (

The use of early enteral nutrition with different routes after gastrointestinal operation

Objectives:To compare the feasibility, complications and advantages of the nose intestine tube and the jejunostic tube in early enteral nutrition after gastrointestinal operation. Methods:55 postoprative patients were divided into three groups. The nose intestine tube group(A group, n =20) and the jejunostic tube group(B group, n =19)received the enteral nutrition(Nutrison Fibre) enterally for 7 days and the conrtrol group(C group, n =16)received intravenous isotonic glucose solution and oral liquid diet after the bowel movement recovery,The blood glucose, the function of liver and kidney, electrolytes and nutritional status were observed. The recovery of bowel movement and other digestive symptoms such as abdominal pain, distention,diarrhea,nausea and vomiting were observed during the period of study. Some complications such as acute intestinal obstruction,pnumonia and rhinolaryngitis were observed during the period of study. Results:The time for placing the jejunostic tube was faster than that for placing the nose intestine tube( P < 0.01 ). The recovery of bowel movement in both A and B group was much earlier than that in C group. When compared with C group, prealbumin and RBP in A or B group were increased significantly( P <0.05, P <0.01). No other significant changes were noted in three groups. Conclusions: Both the nose intestine tube and the jejunostic tube for early enteral nutrition is safe and effective after gastrointeslinal operation. The jejunostic tube for early enteral nutrition is better than the nose intestine tube in shortenning the placing time and the complications of pnuomonia and rhinolaryngitis.