营养不良的胃肠道肿瘤患者术后营养支持的随机对照研究

目的评价术后营养支持对营养不良的胃肠道肿瘤患者预后的影响。方法646例营养不良的胃肠道肿瘤患者随机分为肠外营养组(215例)和肠内营养组(215例)及对照组(216例),术后营养支持7d,采用等热卡125.5kJ(30kcal)·kg-1·d-1]和等氮(0.25g·kg-1·d-1);对照组术后常规补液直至恢复正常饮食。观察比较术后死亡率、并发症发生率及住院时间。结果入选的3组患者资料具有可比性。术后总死亡率为1.5%,3组间差异无统计学意义。术后并发症发生率:肠外营养组33.5%(72例),肠内营养组28.4%(61例),对照组44.9%(97例);对照组与肠外营养组比较,P=0.001;与肠内营养组比较,P=0.000。肠内营养组感染性并发症发生率10.2%,明显低于肠外营养组的15.3%,P=0.002;而两组非感染性并发症发生率差异无统计学意义(21.9%vs.23.7%,P=0.06)。住院时间:肠外营养组(11.2±5.0)d,肠内营养组(9.8±3.4)d,对照组(14.5±7.1)d;肠内营养组住院时间短于肠外营养组,P=0.002;对照组与肠外营养组比较,P=0.003;与肠内营养组比较,P=0.001。结论术后营养支持可改善营养不良的胃肠道肿瘤患者的预后,术后早期肠内营养较肠外营养能降低术后感染性并发症发生率,并缩短住院时间。

A randomized controlled trial of postoperative artificial nutrition in malnourished patients with gastrointestinal cancer

OBJECTIVE: To investigate the potential benefits of postoperative nutrition in malnourished patients with gastrointestinal cancer. METHODS: A total of 646 malnourished patients with gastrointestinal cancer defined by the subjective global assessment (SGA) were randomly divided into parenteral nutrition group (n=215), enteral nutrition group (n=215) and conventional group (n=216). Two nutritional regimens were designed to be isocaloric 125.5 kJ(30 kcal).kg(-1).d(-1) and isonitrogenous 0.25 g.kg(-1).d(-1) for 7 postoperative days. Conventional group did not receive artificial nutrition before and after surgery. Postoperative complications, mortality and postoperative length of hospital stay were compared. RESULTS: All baseline and surgical characteristics were comparable among 3 groups. Overall postoperative mortality was 1.5%, and no difference was observed among 3 groups. Postoperative complications occurred in 61(28.4%) patients in enteral nutrition group, 72(33.5%) in parenteral nutrition group, and 97 (44.9%) in conventional group (P=0.000 vs enteral nutrition group; P=0.001 vs parenteral nutrition group). Postoperative length of hospital stay was (9.8+/-3.4) d in enteral nutrition group, (11.2+/-5.0) d in parenteral nutrition group, and (14.5+/-7.1) d in conventional group (P=0.001 vs enteral nutrition group; P=0.003 vs parenteral nutrition group). CONCLUSIONS: Postoperative artificial nutrition support is beneficial to the malnourished patients with gastrointestinal cancer, which improves postoperative outcome. Early enteral nutrition significantly reduces the infectious complication rate and length of postoperative hospital stay as compared with parenteral nutrition.