高龄胃癌患者术后营养支持的临床研究

目的 探讨老年患者胃癌患者术后肠内肠外营养联合应用的合理性和安全性.方法 39例老年胃癌患者术后随机分为全肠外营养(TPN)组,肠内营养(TEN)组和PN加EN组,每组13例.结果 检测手术前后3组人体测量学指标及血浆白蛋白(Alb),血红蛋白(Hb)和氮平衡变化并进行人体测量学指标和Alb比较,差异均无显著性意义(P＞0.05),术后第1,4,7天PN加EN组氮平衡改善较TEN组明显(P＜0.01).TEN组术后早期(8～12 h)经鼻肠导管营养液滴注后,6例出现腹胀,其中4例伴腹泻,而PN加EN组采用术后48～72 h或听诊可闻及肠鸣音(每分钟3次以上)后方开始输注EN液,则可以较好地耐受.结论 老年胃癌患者术后EN时间应适当延长至48～72h或听诊闻及肠鸣音(每分钟3次以上)开始为宜.在EN支持前可辅以经周围静脉的PN.

Clinical research on the post-operative nutritional support to the aged patients with stomach neoplasm

Objective To explore the rationality and security of application of combination of enteral and parenteral nutrition in the aged patients with stomach neoplasm. Methods 39 aged patients with stomach neoplasm were randomly divided into the total parenteral nutrition group (TPN), the total enteral nutrition group (TEN) and the PN plus EN group, with 13 cases in each group. Results The anthropometric indexes, albumin (Alb), hemoglobin (Hb) and nitrogen balance change were detected in the three groups before and after the operation. The anthropometric indexes were compared with Alb, and all the differences had no significant meaning (P>0.05). But the improvement of nitrogen balance was obvious at the 1st, 4th and 7th day after the operation in the PN plus EN group (P<0.01). 6 cases had windy symptom, and 4 of them had diarrhea additionally through the dripping of nutritional liquid via the nasogastric tube early (8~12 h) after the operation in the TEN group. While the drip of EN fluid was startee 48~72 hours after the operation or when the bowel sounds were heard through the auscultation (over than 3 times per minute), the patients could better tolerate in the PN plus EN group. Conclusions The EN time should be properly prolonged to 48-72 hours, or the EN should be started when the bowel sounds are heard through the auscultation (over than 3 times per minute) for aged patients with stomach neoplasm. The PN through peripheral vein can be provided before the start of EN support.