胃癌术后早期肠内营养三种置管方式效果观察  

Three intubations for early enteral nutrition after gastric cancer surgery

作　　者：陈育民[1] 王绍明[2] 黄俊伟[1] 

机构地区：[1]成都市温江区人民医院普外科,四川温江611130 [2]成都中医药大学附属医院普外科,四川成都610072

出　　处：《实用医院临床杂志》2012年第1期110-112,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨最适合老年胃癌患者术后早期肠内营养的一种置管方法。方法 2007年2月至2011年2月在成都市温江区人民医院普外科行胃癌手术的68例老年患者,根据术后置管方式分成鼻胃管联合空肠营养造口管(或鼻肠管)组、经鼻置三腔胃肠管组和胃造口置三腔胃肠管组,观察三组鼻咽部不适﹑恶心呕吐、肺炎等并发症的发生率以及住院时间、胃引流量、肠内营养给予量、肛门排气恢复时间等。结果胃造口置三腔胃肠管在"畏"管心理、鼻咽部不适、异物感、置管后严重咳嗽、咳痰及置管营养期间恶心、呕吐等发生率与另外两组比较,差异均有统计学意义(P<0.01);且该组术后8日皮褶厚度、上臂肌围长、氮平衡、转铁蛋白和CD4/CD8比值与术前1日比较差异有统计学意义(P<0.05,或P<0.01)。结论术后经胃造口置三腔胃肠管行早期肠内营养,并发症低,耐受性好,尤其适合老年胃手术患者。Objective To discuss the optimal approach of intubation for postoperative early enteral nutrition （EEN） in elderly patients with gastric cancer. Methods Sixty eight elderly patients with gastric cancer were randomly divided into three groups：group 1 with nasogastric tube and nasointcstinal tube, group 2 with Freka Trelumina by naso-approach, and group 3 with Freka Trelumina by gastric approach. Incidence of complaint in pharynx nasalis, nausea and vomiting, pneumonia etc. , and other complications such as length of stay, gastric drainage volume,volume of enteral nutrition, and recovery time of flatus were observed. Results Group 3 was sig- nificantly different compared with the other two groups in fear of intubation, complaint in pharynx nasalis, foreign body sensation, bad cough after intubation, expectoration, and incidence of nausea and vomiting during intubating nutrition period （P 〈 0.01 ）. Skinfold, arm muscle circumference,nitrogen balance,transferring and CIM/CD8 8 days after surgery were significantly different compared with the same above-mentioned indicators 1 day before surgery （P 〈 0.05 or P 〈 0.01 ）. Conclusion Early enteral nutrition with Freka Trelumina by gastric approach has advantages of fewer complications and good tolerance, which is an optimal method for patients after gastric operation, especially for the elder.

关 键 词：老年 胃癌 肠内营养 三腔胃肠管 鼻肠管 置管方式 

分 类 号：R459.3[医药卫生—治疗学] R735.2[医药卫生—临床医学]