食管癌患者术后早期肠内营养支持耐受性及影响因素的研究  

A study on tolerance and influencing factors of early enteral nutritional support in post-operative patients with esophageal cancer

作　　者：韩超[1] 赵艺媛[1] 陶立燕 段宏伟[1] 杜松涛[1] 董潇[1] 韩颖[1] 薛丽丽[1] 唐冲[1] 周秀耕[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究胸外二科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国中西医结合急救杂志》2015年第3期304-306,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨食管癌患者术后早期肠内营养（EN）支持的耐受性情况及其影响因素。方法采用回顾性研究方法，选择2012年9月至2014年7月北京大学肿瘤医院收治的食管癌根治术后患者107例，术后第1天经空肠营养管以20mL／h的速度输注500mL饮用水；术后第2天开始经空肠营养管泵入肠内营养乳剂，初始用量分为200、400、500mL。观察患者性别、年龄（〉4岁和〈60岁）、早期EN的不耐受情况及处理方式、早期EN的起始剂量、过渡到目标总量所用的时间对患者耐受性的影响。结果107例患者于术后平均（2．32±0．71）d开始早期EN，在（5．47±2．57）d内过渡到目标用量；有44例（41．1％）患者发生腹泻或腹胀等不耐受情况，其中12例患者（11．2％）既有腹胀又有腹泻；出现腹胀的时间为术后平均5（3，7）d，出现腹泻的时间为术后平均7（4，10）d。有9例（8．7％）患者因腹痛或腹泻不能耐受而停止早期EN。男性和女性[41．1％（37／90）比41．2％（7／17）]、年龄〈60岁和〉60岁[37．9％（25／66）比46．3％（19／41）]、过渡到目标用量所用时间〈4d和〉4d[42．6％（23／54）比39．6％（21／53）]对EN不耐受发生率的影响差异均无统计学意义（均尸〉O．05）；随着肠内营养液起始剂量的增加（200、400、500mL），患者不耐受情况发生率差异无统计学意义（P〉0．05），但有增加的趋势[分别为：33．3％（11／33）、40．4％（11／27）、46．8％（22／47）]。结论大部分食管癌患者术后可耐受早期EN支持，出现不耐受的患者基本可在治疗后缓解；缩短达到EN支持目标值的时间并不会增加不耐受的发生率。Objective To explore the tolerance and influencing factors of early enteral nutritional （EN） support in post-operative patients with esophageal cancer. Methods A retrospective study was conducted. 107 patients with esophagus cancer after radical esophagectomy hospitalized in the Cancer Hospital of Peking University from September 2012 to July 2014 were enrolled. They received 500 mL drinking water at the speed of 20 mL/h through jejunal nutritional tube on the first day after surgery. On the second day after operation, a nutritional emulsion was pumped into intestine through jejunal nutritional tube with an initial amount different in quantity 200,400 or 500 mL. The patients＇ gender, age （〉 4 years and 〈 60 years）, the situation of intolerance toward the enteral nutrition at early stage and its method of management, initial EN dose at early stage and the influence of time necessary to achieve the target total amount on tolerance were investigated. Results 107 patients began to receive EN on the mean （2.32 ± 0.71） days at early stage after surgery, and passing the mean （5.47 ± 2.57） days the target amount could be reached. Abdominal distension or diarrhea occurred in 41.1% （44 cases） of patients, 11.2% （12 cases） of whom suffered from both abdominal distension and diarrhea. The mean time of abdominal distension onset was 5 （3, 7） days, and that of diarrhea onset was 7 （4, 10） days. Nine patients （8.7%） stopped the early EN because of the intolerance toward abdominal pain or diarrhea. The factors of influences on the incidence of intolerance toward EN having no statistically significant differences （all P 〉 0.05） were as follows： gender, the proportion of male versus female [41.1% （37/90） vs. 41.2% （7/17）], ages 〈 60 years versus 〉 60 years [37.9% （25/66） vs. 46.3% （19/41）] and different times to achieve target total amount 〈 4 days versus 〉 4 days [42.6% （23/54） vs. 39.6% （21/53）]. Along with the increase of the initial amounts （

关 键 词：食管癌术后 肠内营养支持 耐受性 

分 类 号：R657.51[医药卫生—外科学]