胃癌根治术后早期肠内、外营养的对比研究

目的观察胃癌根治术后早期肠内、外营养的疗效比较。方法选取复旦大学附属中山医院青浦分院2009年1月至2011年12月胃癌术后患者90例,随机分为观察组（n=45）和对照组（n=45）,对照组予以肠外营养（PN）,观察组予以早期肠内营养（EEN）。观察两组术后肛门排气时间、住院时间、体重下降、上臂肌围、血红蛋白、白蛋白（ALB）、转铁蛋白（TF）、前白蛋白（PA）、高敏C反应蛋白（hs-CRP）和并发症发生率的情况。结果 EEN组的术后肛门排气时间、住院时间和体重下降均较PN组出现明显缩短或减少（P〈0.05或〈0.01）;治疗后PN组的ALB和TF的水平较治疗前和EEN组出现明显降低（P〈0.01）,两组的AP和hs-CRP水平较治疗前明显降低或者升高（P〈0.01）,PN组的降低或者升高水平更为明显,差异均有统计学意义（P〈0.01）。两组的上臂肌围、血红蛋白水平和术后并发症发生率差异无统计学意义（P〉0.05）。结论 EEN改善胃癌根治术后患者的营养状况,降低炎症反应,是理想的营养支持方式。

A comparative study of postoperative gastric cancer with early enteral nutrition

Objective To evaluate the therapeutic effect of early enteral nutrition and parenteral nutrition on postoperative gastric cancer patients. Methods 90 patients with postoperative gastric cancer from January 2009 to December 2011 were randomly divided into observation group and control group, and each group had 45 cases. The control group received parenteral nutrition （PN）, and the observation group received early enteral nutrition （EEN）. The postoperative flatus, length of stay, weight loss, arm muscle circumference, hemoglobin, albumin （ALB）, transferrin （TF）, prealbumin （PA）, high-sensitive C-reactive protein （hs-CRP） and the rate of complications were observed. Results The postoperative flatus, length of stay and weight loss in the EEN group were shorter or lower than those in the PN group （P0.05 or 0.01）. After treatment, the levels of ALB and TF were significantly lower than those before treatment or in the EEN group （P0.01）. The levels of AP and hs-CRP reduced or increased significantly in two groups than those before treatment （P0.01）, while, the levels of PN group reduced or increased more obviously （P0.01）. The levels of arm muscle circumference and hemoglobin, and the incidence of postoperative complications were similar between the two groups （P0.05）. Conclusions EEN can improve the nutritional status of postoperative gastric cancer patients and reduce inflammation. It is an ideal method of the nutritional support.