老年食管癌患者术后早期肠内营养对预后影响的临床研究

目的 研究老年食管癌患者术后早期肠内营养(EEN)对预后的影响. 方法 将我院2006年1月至2011年6月收治老年食管癌手术患者120例,按不同的营养方式分为2组,EEN组60例,给予EEN支持；肠外营养(PN)组60例,常规深静脉PN,对2组老年患者术后肠功能恢复时间、住院时间、并发症的发生率以及术后1周营养、免疫等相关指标进行统计学分析. 结果 EEN组在术后患者肛门排气时间[(44.3±12.5)h比(73.6±11.8)h]、肛门排便时间[(81.5±15.1)h比(138.1±13.2)h]和住院时间[(14.0±1.9)d比(16.2±3.0)d]均短于PN组(P＜0.05)；EEN组术后1周的血清白蛋白(ALB)、外周血淋巴细胞、转铁蛋白、24h尿素氮(BUN)均高于PN组;EEN组患者的IgG、IgA、IgM及CD3+、CD4+、CD8+、CD4+/CD8+外周血T淋巴细胞亚群等免疫指标较PN组均显著改善,差异均具有统计学意义(P＜0.05)；2组间术后并发症发生方面比较,EEN组明显优于PN组(P＜0.05). 结论 老年食管癌患者术后EEN能促进术后代谢和免疫功能恢复、减少并发症,对患者的预后具有重要的临床意义,值得进一步推广和应用.

Clinical study of the effects of early enteral nutrition on postoperative recovery of elderly patients with easophageal cancer

Objective To investigate the influence of early postoperative enteral nutrition(EEN) on the prognosis of elderly patients with easophageal cancer.Methods From January 2006 to June 2011,120 cases of elderly patients with esophageal cancer surgery,according to different nutrition were divided into two groups,enteral nutrition(EEN) group and parenteralnutrition group(PN).In the former group 60 patients were treated with EEN;and the other 60 received deep vein parenteral nutrition(PN).In the two groups of elderly postoperative patients,recovery time,hospital stay,incidence of complications and a week after surgery,nutrition,immunization and other relevant indicators were statistically analyzed.Results EEN group was shorter in the postoperative flatus(44.3±12.5 h vs.73.6±11.8 h),defecation time(81.5±15.1 h vs.138.1±13.2 h) and hospital stay(14.0±1.9 d vs.16.2±.0 d) than PN group(P<0.05),one week postoperative serum albumin(ALB),peripheral blood lymphocytes,Tf,the 24 h urea nitrogen(BUN) in EEN group were higher than those in PN group;In EEN group,the levels of IgG,IgA,IgM and CD3+,CD4+,CD8+,CD4+/CD8+ peripheral blood T lymphocyte sub-groups such as immunization indicator were significantly improved than those in PN group(P<0.05);The incidence of inter-operation complications in EEN group was significantly lower than that in PN group(P<0.05).Conclusions EEN in elderly patients with esophageal cancer can promote the recovery of postoperative metabolism and immune function,and reduce complications.The prognosis of patients has important clinical significance.It is worthy of further promotion and application.