胃癌全胃切除术后早期肠内营养支持的临床效果观察

目的 探讨胃癌全胃切除术后早期肠内营养支持的临床疗效.方法 将60例行全胃切除术的胃癌患者,随机分为治疗组与对照组各30例.所有患者在综合治疗基础上,对照组术后每日行完全肠外营养支持治疗直到经口进食;治疗组术中留置鼻空肠营养管,术后先行静脉营养支持,第2天开始经鼻空肠营养管滴入肠内营养制剂.观察比较两组术后肠功能恢复首次排气、排便时间;两组患者术后第1、7天的血清白蛋白和血清前白蛋白变化情况;平均住院时间及费用.结果 治疗组肠功能恢复首次排气、排便时间短于对照组（P＜0.01）.两组患者手术后第1天血清白蛋白和血清前白蛋白水平与手术前比较均明显下降,两组间差异无统计学意义（P＞0.05）.两组治疗第7天时血清白蛋白和血清前白蛋白水平均升高,以治疗组更明显（P＜0.05）.治疗组平均住院时间及费用均少于对照组（P＜0.05）.结论 早期肠内营养支持能够促进胃肠功能恢复、改善营养状况、降低医疗费用以及缩短住院时间,是胃癌全胃切除术后的首选营养途径,值得推广应用.

Early enteral nutrition support after total gastrectomy for gastric cancer

Objective To investigate the clinical efficacy of early enteral nutrition support after total gastrec- tomy for gastric cancer. Methods Sixty patients with total gastrectomy of gastric cancer were randomly divided into treatment group and control group, and each group had 30 cases. All patients were treated with conventional treatment. Control group received parenteral nutrition. Patients were given total parenteral nutritional supports as routinely from the first postoperative day until oral feeding. Treatment group were supplied with early enteral nutrition. Patients were given parenteral nutritional supports routinely on the I~ postoperative day, and then with nutrition through nasal jeju- nal nutrition tube infusion, gradually increasing the dosage and reducing the venous support. The first exhaust and def- ecate time recovery of intestinal function were compared between two groups. The changes of serum albumin and se- rum prealbumin were calculated after postoperative l day and 7 days. Meanwhile, the average length of hospital stay and cost were compared. Results Compared with those in control group, the first exhaust and defecate time recovery of intestinal function in treatment group were short （P〈0.01）. Patients in two groups before 1 day after the operation, serum albumin and serum prealbumin levels were significantly decreased compared with those before the operation, but the differences between two groups were not statistically significant （/〉〉0.05）. Two groups after treatment the se- rum albumin and serum prealbumin levels at 7 days decreased, in treatment group decreased more obvious （P〈0.05）. The average hospitalization time and cost were lower in treatment group than those in the control group （P〈0.05）. Conclusion Early enteral nutrition support can promote gastrointestinal function recovery, improve nutrition, reduce medical costs, and shorten hospitalization time, and hence is the f＇trst choice for gastric cancer after total gastrectomy.