肠内营养在老年直肠癌患者术前的应用  

Application of Preoperative Enteral Nutrition in Elderly Rectal Cancer Patients

作　　者：余雄[1] 万焱华[1] 吴崇杰[1] 

机构地区：[1]九江市第一人民医院普外科,江西九江332000

出　　处：《实用临床医学（江西）》2011年第4期51-53,56,共4页Practical Clinical Medicine

摘　　要：目的探讨肠内营养对老年直肠癌患者术后胃肠功能紊乱的预防。方法对50例老年行直肠癌根治术患者按随机数字表法分为2组:试验组和对照组,每组25例。试验组术前3 d采用短肽型肠内营养剂替代传统流质饮食,术前禁食12 h,禁水4 h,术前常规清洁灌肠;对照组术前3 d采用传统流质饮食(米汤、粥、菜汤等),术前禁食12 h,术前常规清洁灌肠。2组患者术前2 d均常规口服肠道抗生素。观察2组患者术中肠道清洁度、术后有无并发症发生(腹泻、功能性肠梗阻、胃肠功能紊乱)及术前第3天、术后第1天血常规(淋巴细胞总数、WBC计数)及肝功能[血清丙氨酸氨基转移酶(ALT)、血清碱性磷酸酶(ALP)]、肾功能[血清总蛋白(TP)、白蛋白(ALB)]的变化等情况。结果试验组、对照组术中肠道清洁度优良率分别为80.0%、80.0%,2组比较差异无统计学意义(P>0.05);试验组和对照组腹泻、功能性肠梗阻、胃肠功能紊乱发生率分别为4.0%、0.0%、0.0%和16.0%、8.0%、8.0%,2组比较差异均有统计学意义(均P<0.05);试验组术后第1天淋巴细胞总数、ALT水平与对照组比较差异均无统计学意义(均P>0.05);试验组术后第1天WBC计数明显低于对照组、试验组术后第1天ALB、TP、ALP水平均明显高于对照组,差异均有统计学意义(均P<0.05);试验组术前第3天淋巴细胞总数、ALT、WBC计数、ALB、TP、ALP水平与对照组比较差异均无统计学意义(均P>0.05)。结论掌握老年直肠癌患者机体的特殊性,术前肠内营养可以降低直肠癌术后胃肠功能紊乱的发生率,有效预防胃肠功能紊乱。Objective To explore the role of preoperative enteral nutrition in the prevention of postoperative gastrointestinal dysfunction in elderly rectal cancer patients.Methods Fifty elderly patients with rectal cancer were randomly divided into test group and control group,with 25 patients in each group.The test group was given peptide-based enteral nutrition instead of traditional liquid diets,and was treated with 12-hour fasting,4-hour water deprivation,and cleansing enema preoperatively.The control group started traditional liquid diets（rice soup,porridge,soup,etc） 3 days before surgery,and received preoperative 12-hour fasting and preoperative cleansing enema.Conventional oral antibiotics were preoperatively used for 2 days in all patients.Intraoperative intestinal cleanliness and postoperative complications were observed.Routine blood tests and assessment of liver and kidney function were performed at preoperative day 3 and postoperative day 1.Results There were no differences in excellent rate between test group and control group（80.0% vs 80.0%,P0.05）.Compared with control group,the incidence of diarrhea,functional intestinal obstruction and gastrointestinal dysfunction significantly decreased in test group（4.0%,0.0% and 0.0% vs 16.0%,8.0% and 8.0%,respectively;all P0.05）.There were no differences in total lymphocyte count and serum alanine aminotransferase（ALT） levels between the two groups at postoperative day 1（all P0.05）.Compared with control group,the levels of white blood cell（WBC）counting decreased and the levels of albumin（ALB）,total protein（TP） and alkaline phosphatase（ALP）increased in test group at postoperative day 1（all P0.05）.At preoperative day 3,total lymphocyte count and levels of ALT,WBC,ALB,TP and ALP were not significantly different between the two groups（all P0.05）.Conclusion Preoperative enteral nutrition is effective for the prevention of postoperative gastrointestinal dysfunction in elderly rectal cancer patients.

关 键 词：直肠癌 短肽型肠内营养剂 术前 胃肠功能紊乱 老年人 

分 类 号：R735.37[医药卫生—肿瘤]