结直肠癌患者术后早期给予肠内营养的随机对照研究

目的：探讨结直肠癌患者术后早期给予肠内营养的安全性和有效性。方法前瞻性纳入2013年3-12月间青岛大学医学院附属医院普通外科收治的88例结直肠癌患者，按随机数字表法分为早期肠内营养组（43例，术后早期开始进食水和肠内营养制剂）和早期禁食组（45例，常规早期禁食方案）。比较两组患者术后恢复情况、并发症发生率、营养状况及应激等指标。结果与早期禁食组相比，早期肠内营养组患者术后发热时间缩短[（53．7±5．9） h比（64．5±5．8） h]，排气时间提前[（57．5±8．2） h比（71．8±7．2） h]，住院时间缩短[（6．9±1．4） d比（8．5±1．9） d]，治疗费用减少[（41868±3168）元比（45950±3714）元]（均P＜0．01）。两组患者术后并发症发生率的差异无统计学意义[18．6％（8/43）比22．2％（10/45）， P＞0．05]。早期肠内营养组患者术后第3和第7天白蛋白、前白蛋白和视黄醇结合蛋白水平明显高于早期禁食组，而静息能量消耗和胰岛素抵抗指数明显低于早期禁食组（均P＜0．05）。结论结直肠癌患者术后早期给予肠内营养安全有效，符合人体生理性营养吸收途径，可改善术后营养状况，降低应激反应，促进患者康复。

A randomized control study of early oral enteral nutrition after colorectal cancer operation

Objective To observe the safety and efficacy of early oral enteral nutrition after colorectal cancer operation. Methods A total of 88 colorectal cancer patients in our department from March 2013 to December 2013 were prospectively enrolled in the study and randomly divided into early enteral nutrition group （43 cases, receiving early water and enteral nutrition after operation） and early fasting group （45 cases, receiving conventional postoperative care protocol） based on the random number table. The postoperative recovery, complication morbidity, nutritional status and stress were compared between the two groups. Results Compared to early fasting group, patients in early enteral nutrition group had a significantly shorter duration of postoperative fever [（53.7±5.9） h vs. （64.5± 5.8） h, P〈0.01], a shorter interval to flatus [（57.5±8.2） h vs. （71.8±7.2） h, P〈0.01], a shorter hospital stay[（6.9±1.4） d vs. （8.5±1.9） d, P〈0.01] and lower medical cost [（41 868±3168） Yuan vs. （45 950±3714） Yuan, P〈0.01]. There was no significant difference in complication morbidity between the two groups [18.6%（8/43） vs. 22.2%（10/45）, P〉0.05]. The albumin, prealbumin, and retinol binding protein on the third and seventh postoperative days were significantly higher in early oral enteral nutrition group （P〈0.05）, while the rest energy expense （REE） and lnHOMA-IR were significantly lower as compared to early fasting group （all P〈0.05）. Conclusion Early oral enteral nutrition after colorectal cancer operation is safe and effective , which is a natural route of nutrition and can reduce the stress response related to surgery, improve postoperative patients′ nutritional status and accelerate rehabilitation.