食管癌合并糖尿病的围手术期营养支持  

Perioperative nutrition support for esophageal cancer complicated with diabetes mellitus

作　　者：柳硕岩[1] 陈啸风[1] 王枫[1] 郑庆丰[1] 王健键[1] 

机构地区：[1]福建医科大学附属福建省肿瘤医院胸外科一区,福州350014

出　　处：《中华胃肠外科杂志》2013年第9期864-867,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 比较围手术期肠内与肠外营养支持对于合并糖尿病的食管癌患者的治疗效果.方法 前瞻性入组2012年9-11月间福建省肿瘤医院胸外科收治的30例合并糖尿病的食管癌患者,按随机数字表法将其随机分为肠内营养组（15例）和肠外营养组（15例）.两组于术前3d至术后8d期间分别给予肠内营养素（安素）和肠外营养支持.每日动态监测血糖；术前1d和术后8d检测患者的营养指标（白蛋白和前白蛋白）；观察术后胃肠道功能恢复时间和营养支持相关并发症发生率;统计营养支持总费用.结果 两组患者围手术期血糖控制情况均较为满意：3餐前手指末梢血糖为5.0～9.0 mmol/L,3餐后2h手指末梢血糖为7.0～10.0 mmol/L,晚10时和凌晨3时的血糖波动于4.0～8.0 mmol/L;所有患者均未出现低血糖（末梢血糖小于3.5 mmol/L）.肠内营养组术后首次排气时间为（62.4±15.7）h,明显快于肠外营养组的（90.8±22.4） h（P＜0.01）.两组患者术后营养指标及营养支持相关并发症方面的差异均无统计学意义（均P＞0.05）.肠内营养组营养支持费用为 （650.8±45.8）元,明显低于肠外营养组的（3016.5±152.6）元（P＜0.01）.结论 在合并糖尿病的食管癌患者中,围手术期营养支持能在有效调控血糖的同时明显改善其营养状况.与肠外营养相比,使用安素进行肠内营养能加快胃肠功能恢复,并降低营养支持的费用.Objective To compare the efficacy between perioperative enteral and parenteral nutrition support for esophageal cancer patients complicated with diabetes mellitus.Methods Thirty esophageal cancer patients complicated with diabetes mellitus between September and November 2012 were prospectively enrolled in this trial.According to random number table,30 cases were randomly divided into enteral group（n=15） and parenteral group（n=lS）.During the period between 3 days before operation and 8 days after operation,patients received enteral nutrition （AnSure） and parenteral nutrition support respectively.The daily dynamic monitoring of blood glucose was performed.Nutritional indexes （albumin and prealbumin） were evaluated 1-day before operation and 8-day after operation.Postoperative recovery time of gastrointestinal function and complications associated with nutritional support were observed.The cost of nutritional support was calculated.Results Patients in the two groups achieved satisfactory perioperative blood glucose control.Finger tip blood glucose was 5.0-9.0 mmol/L before meal,7.0-10.0 mmol/L 2-hour after meal,and 4.0-8.0 mmol/L at 10 PM and 3 AM.No hypoglycemia （〈3.5 mmol/L） was found in all the patients.The time to first flatus after surgery was （62.4±15.7） in the enteral group,significantly earlier than （90.8±22.4） h in the parenteral group （P〈0.01）.Postoperative nutritional indices and associated complications were not significantly different between two groups（all P〉 0.05）.Cost in the enteral group was significantly lower than that in the parenteral group [（650.8±45.8） RMB vs.（3016.5±152.6） RMB,P〈0.01].Conclusion Perioperative nutrition support can effectively control blood glucose and improve perioperative nutritional status simultaneously for esophageal cancer patients with diabetes mellitus.Compared with parenteral nutrition,enteral nutrition can accelerate the recovery of gastric bowel function and reduce the cost of nutritional support.

关 键 词：食管肿瘤 糖尿病 肠内营养 肠外营养 治疗效果 

分 类 号：R735.1[医药卫生—肿瘤] R587.1[医药卫生—临床医学]