胃癌术后的早期肠内营养支持

目的 :观察、比较胃癌术后肠内与肠外营养的效果。方法 :4 4例胃癌术后病人分为早期肠内营养 (EN)组和肠外营养(PN)组。EN组术后 2 4h启动经鼻肠管输注肠内营养制剂 ,给热卡 2 5～ 30kcal·kg-1·d-1,氮 0 .18g·kg-1·d-1,热氮比为 134∶1,PN组经外周静脉输注 ,热量 2 5～ 30kcal·kg-1·d-1,由葡萄糖及 30 %Intralipid分别提供 5 0 %的热量 ,氮 0 .18g·kg-1·d-1(氮源为 8.5 %乐凡命 ) ,共 7d。结果 :两组均顺利完成营养计划。两组术后体重均低于术前 ,有显著差异 (P <0 .0 5 )。TP、PA、ALB组内比较PN组均下降明显 ,有显著差异 (P <0 .0 5 ) ,组间比较PN组PA下降有极显著差异 (P <0 .0 1)。对肝功能的影响PN组术后AST、ALT、GGT升高较明显 ,有极显著差异 (P <0 .0 1) ,组间比较PN组术后GGT升高有极显著差异 (P <0 .0 1) ,术后经口进食时间EN组早于PN组 ,有极显著差异 (P <0 .0 1)。结论 :胃癌术后早期肠内营养是安全可行、有效的。EN对于改善营养状况、维持机体血浆蛋白水平优于PN ;与PN相比 ,EN对肝功能影响较小 ,术后经口进食时间提前。

The Early Enteral Nutritional Support in Postoperation of Datients with Gastric Carcinoma

Objective: Observe and compare the result of the parenteral and enteral nutrition. Methods:Forty-four patients undergone the surgery of gastric carcinoma were divided into two groups. One is the group of early enteral nutrition. The other is the group of parentetal nutrition. Patients in EN group had a naso-jejunal tube inserted during the surgery. The enteral feeding was started within the first 24 hours post operatively and continued for consecutive 7 days. Patients in PN group were provided via peripheral vein for 7 days.Results: Two groups all complete the nourishment plan smoothly. The body weight of the two groups after surgery is lower than before surgery. There is a significant difference (P<0.05). There are significant differences in PN group in the decrese of the level of TP, PA and ALB (P<0.05). There is more significant difference in the decrese of the level of PA in PN group. The influence to the liver function. The level of AST, ALT, GGT go up more obviously (P<0.01) in PN group. Group comparison, the GGT after surgery go up obviously (P<0.01) in PN group. The time of oral diet is earlier. Conclusion:After the surgery of gastric carcinoma,early period enteral nutrition is safe, viable and effective; EN is better to maintain the level of blood protein; Compared with PN, the EN affect to liver function slightly, the time of oral diet after surgery is earlier.