进展期胃癌术后早期肠内-肠外营养联合应用与肠外营养的临床比较

目的探讨进展期胃癌术后早期肠内营养和肠外营养联合应用的可行性、安全性和临床效果。方法62例进展期胃癌患者术后第一天随机分为(1)肠外营养(PN)组;(2)肠内和肠外联合营养(EN-PN)组;(3)对照组。观察在治疗过程中3组患者并发症的发生率、术后肠功能恢复时间、平均住院天数及营养评定的各项指标,进行对比分析。结果对照组并发症发生率明显高于EN-PN组和PN组(P<0.05)。对照组术后胃肠功能恢复时间及平均住院天数较EN-PN组和PN组明显延长(P<0.05),而EN-PN组与其余两组比较显著缩短(P<0.05)。EN-PN组和PN组术后血清白蛋白、前白蛋白和转铁蛋白在营养支持后均明显升高(P<0.05),体重下降缓慢,负氮平衡均得到有效纠正。结论进展期胃癌术后早期肠内营养及肠外营养联合应用安全、可行,在改善机体营养状况方面与全肠外营养相似,并有促进和维护胃肠道功能的作用,同时费用较低。

Clinical Comparative Studies on Application of Combination of Early Post-operative Enteral Nutrition with Parenteral Nutrition for Advanced Gastric Cancer

ObjectiveTo explore the feasibility and safety of early post-operative enteral nutrition with par-enteral nutrition for advanced gastric cancer.MethodsSixty-two patients with advanced gastric cancer were randomly divided into three groups:parenteral nutrition(PN)group,enteral nutrition with parenteral nutrition(EN-PN)group and control group.The rate of complication,recovery time of the gut function,average hospitalization time,levels of serum albumin,prealbumin and transferrin,levels of nitrogen ba-lance,and change of body weight were observed in three groups.The therapeutic effects of post-oper-ational nutritional support were studied.ResultsThe rate of complication in control group was signi-ficantly higher than those of EN-PN and PN groups(P<0.05).The recovery time of the gut function after operation and average hospitalization time of the control group were longer than those in the EN-PN and PN groups(P<0.05).The bowel movement resumed significantly earlier in the EN-PN group than in the other two groups(P<0.05).The levels of serum albumin,prealbumin and transferrin significantly increased after nutritional support both in the EN-PN and PN groups(P<0.05),while the decline in body weight attenuated as compared with the control group.The recovery of the levels ofnitrogenbalance in the EN-PN and PN groups were significantly faster than that of the control group(P<0.05).Conclusions The combination of early post-operative enteral nutrition with parenteral nu-trition for advanced gastric cancer is safe,feasible and cost-effective.While producing similar nutritional effects as that of PN,EN-PN is superior to PN in terms of resumption of gastrointestinal function.