全胃切除术后早期管饲效果研究

目的评价全胃切除术后早期管饲的安全性，比较术后短期管饲与标准肠外营养支持的疗效。方法对我院1998年1月～2000年1月20例全胃切除术后病人随机分为管饲营养组和肠外营养组，试验周期为术后7天。全部病人均为全胃切除空肠p型代胃，食管空肠吻合口距远端空肠吻合口为40cm，鼻肠管放置于远端空肠吻合口以下。管饲营养组术后第2天开始管饲，第1次滴入生理盐水500ml，4小时后滴入安素250ml(250kcal)，再4小时后滴入安素250ml(250kcal)，速度均为40～50ml/h。以后每日分为三次，间隔3～4小时。术后第3天，滴入安素750～1000ml(750～1000kcal)，速度为60～80ml/h。第4～7天，滴入安素1500～1750ml(1500～1750kcal)，速度为100～120ml/h。肠外营养组能量25～30kcal*kg-1*d-1供给。检测体重、机体测量指标、水电解质变化(包括出入量、尿比重、尿糖、尿丙酮、血清电解质、血糖)、血红蛋白、血清总蛋白、白蛋白、血清尿素氮、肌酐、血清总胆固醇、血清甘油三脂和外周血淋巴细胞。结果本组病例均未发生吻合口瘘，管饲营养组和肠外营养组在体重、机体测量指标、血浆蛋白浓度、氮平衡指标、外周血淋巴细胞均无显著差异。讨论全胃切除术后早期管饲营养的方法安全有效，管饲营养与肠外营养效果基本相近。管饲营养密切观察护理，及时调节滴入速度，不会引起误吸、恶心、呕吐、腹泻、低蛋白血症和电解质紊乱的症状发生。费用低，适合于基层医院开展。

Effect of early enteral nutrition in patients undergoing total gastrectomy

Objective To evaluate the safety and effect of early enteralnutrition support in patients undergoing total gastrectomy. Methods 30 patients undergoing total gastrectomy were randomized into two groups:study group (PN and early EN),control group (PN).Patients in study group received enteral feeding from 24 hours after operation starting with normal saline.Insure was given in 4 hours with the rate of 40-50ml/h, and the amount of Insure increased gradually till EN became the only nutrition support way on the 3rd postoperative day.The nutrition support formula was isocaloric (30kcal/kg/day) and isonitrogenic(0.15g/kg/day)between the two groups.Body weight,anthropometry,nitrogen balance,hemoglobin,plasma albumin,and lymphocyte count was evaluated on the 7th postoperative day. Result There were no significant defference in body weight,anthropometry,nitrogen balance,hemoglobin,plasma albumin,and lymphocyte count between two groups. Conclusion Enteral nutrition in the early period after abdominal surgery is safe and effective.Enteral feeding is suitable to primary level hospitals because of low cost.