胃癌术后早期营养支持的应用

目的探讨胃癌术后病人早期不同营养支持方法的应用价值。方法将56例胃癌根治术后病人随机分为两组,分别进行全肠外营养支持(TPN组)和肠内联合肠外营养支持(CEP组),分别于术后24 h后予营养支持。观察在治疗过程中两组病人术后并发症的发生率、胃肠功能恢复时间、术后平均住院天数、免疫指标及营养评定等各项指标进行对比分析。结果两组病人术后并发症的发生率、胃肠道功能恢复时间、平均住院天数CEP组明显低于TPN组(P<0.05);两组术后血浆总蛋白(TP)、血浆白蛋白(ALB)、血红蛋白(HGB)和体质量(BW)在营养支持后均有所下降(P<0.05),TPN组淋巴细胞计数(LY)减少(P<0.05),CEP组LY差异无显著性意义(P>0.05);两组营养及免疫指标组间差异无显著性意义(P>0.05)。结论胃癌术后早期肠内营养联合肠外营养,在改善机体营养状况方面与全肠外营养相似,在加快免疫状态改善,降低并发症发生率方面要优于全肠外营养,能更好地提高病人的生活质量。

The application of early nutritional support after gastric cancer surgery

Objective To explore the significance of early nutritional support after gastric cancer surgery with various methods.Methods Fifty six patients with gastric carcinoma undergone major surgery were randomly divided into TPN group and CEP group.The nutritional support started from 24 hours after operation.The incidence rate of complications,duration for recovery of gastrointestinal function,average duration of postoperative hospitalization,immunological indexes and assessment of nutritional status in patients of these two groups were compared and analyzed.Results The incidence rate of complications,duration for recovery of gastrointestinal function and average duration for postoperative hospitalization in patients of CEP group were shorter than those of patients in TPN group after surgery（P0.05）.The plasma levels of total protein,albumin,hemoglobin and body weight in patients of two groups were decreased after operation（P0.05）.The lymphocyte count in peripheral blood of patients in TPN group was reduced after operation（P0.05）.There was no significant decrease in level of peripheral blood lymphocyte count in patients of CEP group（P0.05）.There was no significant difference in level of peripheral blood lymphocyte count and nutritional status and immunological indices between TPN group and CEP group.Conclusion The effect of early postoperative CEP after gastric cancer surgery is similar to that of TPN in improvement of nutritional status of patients.CEP is better than TPN in reducing the incidence rate of complications.Therefore CEP is better in raising the life quality of patients after gastric surgery.