肝癌合并糖尿病患者术后的进食水方案  

Postoperative Drinking and Eating Program for Patients with Liver Cancer Combined Diabetes

作　　者：陆丽华[1] 陈萃[1] 付立[2] 纪丹妮[1] 王葵[1] 施乐华[1] 叶志霞[2] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外四科,上海200433 [2]第二军医大学东方肝胆外科医院护理部

出　　处：《解放军护理杂志》2015年第21期6-10,共5页Nursing Journal of Chinese People's Liberation Army

基　　金：第二军医大学青年启动基金资助项目(2011QN21)

摘　　要：目的探讨适合肝癌合并糖尿病患者术后进食水方案。方法2011年8月至2013年7月，便利抽样法选取某医院住院治疗的120例肝癌合并糖尿病患者为研究对象，按随机数字表法将其分为观察组和对照组，每组60名。观察组患者术后4～6h夹闭胃管，分次饮温水，于术后12h鼓励患者进流质、术后24h拔除胃管进半流质；对照组患者术后常规留置胃管，待肛门恢复排气后进流质，逐步过渡。比较两组患者围术期糖代谢、应激及肝功能指标变化等。结果观察组患者术后首次排气、排便时间均早于对照组（均P〈0．01）。且术后6h饥饿感、术后12h口渴感和食欲情况，术后24h口渴、焦虑感、食欲情况，术后48h口渴、饥饿、焦虑感、腹部不适情况、食欲情况较对照组均有改善（P〈0．05或P〈0．01）。两组患者不同时间点的各项指标比较，时间因素对血清胰岛素、IR指标、c反应蛋白、丙氨酸氨基转移酶（alanineaminotransferase，ALT）、天门冬氨酸转移酶（aspartateaminotransferase，AST）、前白蛋白（prealbumin，PrmAlb）均存在主效应（P〈0．05或P〈0．01）；干预因素对c反应蛋白、IR指标、血清c肽存在主效应（P〈0．05）；干预因素和时间因素对IR指标及c反应蛋白存在交互作用（P〈0．05）。结论术后早期进食可改善患者主观感受。To explore a suitable drinking and eating program for patients with liver cancer combined with dia- betes.Methods By convenience sampling, 120 patients were selected and equally divided into observation group and control group.Patients in observation group had clip gastric tube after 4h to 6h in postoperative period,and drank warm water, given liquid diet after 12h,removed gastric tube after 24h. Patients in control group had conventional gastric intubation,and then gradually transition to full diet.Compare two groups of patients with postoperative metabolism,stress and changes of liver function indexes.Results The observation group patients first flatus and defecation time after operation was earlier than the control group （all P〈0.01）＇.The hunger in 6 h after operation, thirst and appetite in 12h, thirst,anxiety and appetite in 24 h,thirst,hunger, anxiety, abdominal discomfort feelings and appetite in 48 h in postoperative period of obser- vation group were improved compared with which in control group （P〈0.05 or P〈0.01）.The comparison of each index in different time point between two groups,of which the time factor had main effect in serum insulin,IR index, C-reactive protein values, alanine aminotransferase, aspartate aminotransferase and prealbumin （P 〈 0.05 or P 〈 0.01）. Intervention factor had main effect in C-reactive protein values,IR index and serum C-peptide values （P〈0.05）.The intervention factor and time factor had interactive effect in IR index and C-reactive protein values（P〈0.05）.Conclusion Early drinking and eating program in postoperative period can help to improve the objective feeling of patients.

关 键 词：肝癌 糖尿病 围术期 早期进食 

分 类 号：R735.7[医药卫生—肿瘤]