营养筛查下针对性早期肠内营养对消化道肿瘤患者化疗并发症和营养状况的影响

目的探究营养筛查下针对性早期肠内营养(EN)对消化道肿瘤患者化疗并发症和营养状况的影响。方法选取2015年1月—2016年12月间于丽水市中心医院就诊的108例消化道肿瘤患者,采取营养风险筛查2002(NRS2002)表对其进行风险评估,将其中有营养风险的98例患者随机分为常规组(49例)和观察组(49例),术后分别给予延迟和早期EN,随访1年,比较2组患者化疗前后的营养状况、免疫功能、术后恢复情况、化疗并发症以及化疗终止情况。结果化疗后2周,观察组体重、TP、ALB、HB以及皮褶厚度显著高于常规组(均P<0.05);观察组CD4^+、CD8^+、CD4^+/CD8^+、Ig G以及Ig A水平显著高于常规组(均P<0.05);观察组术后肠鸣音恢复时间、肛门排气时间、下床活动时间以及住院时间显著低于常规组(均P<0.05);2组患者吻合口感染与出血发生率差异无统计学意义(均P>0.05);观察组化疗后并发症发生率低于常规组(8.16%vs.28.57%,P=0.029);观察组患者化疗终止率明显低于常规组HR=0.396,95%CI(0.195,0.803),P=0.011]。结论营养筛查下针对性早期肠内营养可以提高消化道肿瘤术后患者的营养状况,增强免疫功能,缩短住院时间,减少化疗并发症发生率并提高化疗耐受力。

The effect of early enteral nutrition on chemotherapeutic complications and nutritional status of patients with digestive tract cancer under nutritional screening

Objective To explore the effect of early enteral nutrition on chemotherapeutic complications and nutritional status of patients with digestive tract cancer. Methods From January 2015 to January 2016, 108 patients with digestive tract tumors treated in our hospital were selected, and nutritional risk screening 2002 (NRS2002) was used to assess the risk of the patients. A total of 98 patients with nutritional risk were randomly divided into the routine group (49 cases) and the observation group (49 cases), and were given delayed and early enteral nutrition respectively after the operation. Both groups were followed up for 1 year, while the nutritional status, immune function, postoperative recovery situation, chemotherapeutic complications and chemotherapy termination situation were compared between the two groups before and after chemotherapy. Results Two weeks after chemotherapy, the weight, TP, ALB, HB and skin fold thickness in the observation group were significantly higher than those in the control group (all P<0.05). The levels of CD4+, CD8+, CD4+/CD8+, IgG and IgA in the observation group were significantly higher than those in the control group (all P<0.05). The postoperative bowel sound recovery time, anus exhaust time, out-of-bed activity time and hospitalization time were significantly lower than those of the control group (all P<0.05). There was no significant difference in the incidence of anastomotic infection and bleeding between the two groups (all P>0.05); The incidence of complications after chemotherapy in the observation group was lower than that in the conventional group (8.16% vs. 28.57%, P=0.029).The termination rate of chemotherapy in the observation group was significantly lower than that in the conventional group HR=0.396,95% CI (0.195, 0.803), P=0.011]. Conclusion If the patients after digestive tract tumor surgery were given early enteral nutrition under nutritional screening, it can improve the nutritional status, enhance the immune function, shorten the hospitalization time, reduce the incidence of chemotherapy complications and improve the tolerance of chemotherapy.