老年胃癌术后早期营养支持方式临床研究

目的探讨老年胃癌术后合理的早期营养支持方式。方法前瞻性入组2010年1月至2013年3月间厦门大学附属第一医院收治的120例老年胃癌术后患者，按随机数字表法分为完全肠外营养组（TPN）、完全肠内营养组（TEN）及部分肠内加肠外营养组（EN加PN），每组40例。比较3组患者营养支持治疗耐受性、术后7d营养指标和免疫指标、术后肛门排气时间及感染并发症发生率。结果在营养支持过程中，EN加PN组耐受性（97．5％，39／40）明显高于TPN组（82．5％，33／40）和TEN组（80．0％，32／40）（P〈0．05）。术后7d，3组患者体质量指数、血浆白蛋白、前白蛋白及转铁蛋白水平等营养指标的差异均无统计学意义（P〉0．05）；但EN加PN组和TEN组CD3、CD4、CD4／CD8等免疫指标明显高于TPN组（均P〈0．05）。EN加PN组和TEN组感染发生率明显低于TPN组5．13％（2／39）和6．25％（2／32）比12．12％（4／33），P〈0．05]，肛门排气时间明显快于TPN组f（49．5±22．1）h和（48．2±17．6）h比（68．2±16．7）h，P〈0．05]。结论老年胃癌术后早期行肠内营养安全可行．EN加PN为最佳的早期营养支持方式。

Study on early postoperative nutritional support in elderly patients with gastric cancer

Objective To explore the optimal postoperative nutritional support in elderly patients with gastric cancer. Methods One hundred and twenty elderly patients with gastric cancer undergoing radical gastrectomy were prospectively enrolled from January 2010 to March 2013 and randomly divided into total parenteral nutrition group（TPN, n=40）, early total enteral nutrition group （TEN, n=40） and enteral plus parenteral nutrition group （EN＋PN, n =40）. Clinical charasteristics including treatment tolerance, nutritional indexes, immune indexes, time to first flatus, incidence of postoperative infection and anastomotic leakage, were analyzed and compared. Results Treatment tolerance in EN＋PN group（97.5%,39/40） was significantly higher than that in TPN group（82.5%,33/ 40） and TEN group （80.0% ,32/40）（both P〈0.05）. The nutritional indices, including prealbumin, albumin, transferrin, body mass index, and the incidence of anastomotic leakage were similar in the 3 groups （P〉0.05）. The immune indices, including CD3, CD4, CD4/CDS, were significantly reduced after operation in each group. However, they were significantly higher in EN ＋PN group and TEN group than those in TPN group （both P〈0.05）. Furthermore, compared to the TPN group, the incidence of postoperative infection （surgical site infection, pulmonary infection, abdominal infection） was significantly lower and time to first flatus was significantly shorter in EN＋PN group and TEN group. Conclusions Early enteral nutrition after gastric cancer surgery is safe, simple and feasible. EN plus PN is the best way to administer postoperative nutritional support in elderly patients with gastric cancer.