胃癌患者术后早期肠内营养对临床结局的影响

目的观察术后早期肠内营养对胃癌患者临床结局的影响。方法将2010年7月至2011年5月间青岛大学医学院附属医院收治的60例胃癌患者按随机数字表法分为试验组和对照组．每组30例。试验组患者术后早期少量多次进水加肠内营养制剂,对照组患者术后采用传统围手术期治疗方案。比较两组患者临床结局、术后免疫功能及营养状况。结果试验组与对照组患者术后发热时间[（81．1±6．4）h比（87．3±8．0）h,P〈0．05]、排气时间[（79．9±9．5）h比（86．6±8．7）h,P〈0．05]和住院时间[（7．83±2．23）d比（9．57±1．96）d,P〈0．01]比较,差异均有统计学意义;治疗费用分别为（30．22±3．22）千元和（34．60±32．12）千元,差异亦有统计学意义（P〈0．01）;两组术后并发症发生率的差异无统计学意义[13．3％（4／30）比16．7％（5／30）,P〉0．05]。术后第3和第7天,试验组患者CD3＋、CD4＋、NK细胞、CD4／CD8、白蛋白和前白蛋白水平均明显高于对照组（均P〈0．05）,而CD8＋细胞显著下降．与对照组比较．差异亦有统计学意义（P〈0．05）。结论术后早期经口进食肠内营养制剂能够改善胃癌患者术后营养状况以及免疫功能,促进肠道功能早期恢复。

Effect of early oral enteral nutrition on clinical outcomes after gastric cancer surgery

Objective To investigate the effect of early oral feeding with enteral nutrition preparation after surgery on clinical outcomes in patients with gastric cancer. Methods Sixty patients with gastric cancer undergoing radical operation between July 2010 and May 2011 were randomly divided into two groups using random digit table： experimental group （n=30, administration of water and enteral nutrition early after surgery） and control group （n=30, conventional postoperative care protocol）. Clinical outcomes, immune function, and nutritional status between the two groups were compared. Results As compared to the control group, duration of fever was significantly shorter in the experimental group [ （81.1±6.4） h vs. （87.3±8.0） h, P〈0.05）, as were postoperative time of flatus[ （79.9±9.5） h vs. （86.6± 8.7） h, P〈0.05） and postoperative hospital stay [ （7.83±2.23） d vs. （9.57±1.96） d, P〈0.01 ]. The medical cost [（30,220±3,220） RMB vs. （34,600±32,120） RMB, P〈0.01] was lower than that in the control group. There was no significant difference in morbidity between the two groups [ 13.3%（4/30） vs. 16.7% （5/30） ,P〉0.05]. The levels of CD3＋T, CD4＋, NK cell, CD4＋/CD8＋T, albumin, and prealbumin were higher in the experimental group as compared to the control group on postoperative day 3 and 7 （P〈0.05）. Conclusion Early oral feeding with enteral nutrition preparation after surgery can improve the nutritional status and immune function, and accelerate the rehabilitation for patients with gastric cancer.