老年胃癌患者围手术期营养评估及术后早期肠内营养的临床研究  

Research on the nutritional risk in elderly patients with gastric cancer and clinical study of early enteral nutrition support in the postoperative elderly gastric cancer

作　　者：叶春[1] 张忻平[1] 王希泽[1] 张雪峰[1] 

机构地区：[1]沈阳军区总医院普通外科,辽宁沈阳110840

出　　处：《东南国防医药》2015年第6期579-582,共4页Military Medical Journal of Southeast China

摘　　要：目的评估老年胃癌患者围手术期的营养状况,为营养支持提供依据,观察术后早期肠内营养的临床价值。方法选取2014年4月-2015年3月我院收治58例老年胃癌患者作为研究对象,应用营养风险筛查2002(NRS2002)进行营养评估,3分以下的10例患者未进行营养支持治疗(NN)。将存在营养风险的48例患者随机分为早期肠内营养(EN)组和肠外营养(PN)组,EN组23例术中置鼻肠管,给予早期肠内营养治疗,TPN组25例给予肠外营养治疗,比较两组的临床指标、胃肠功能和术后并发症、营养状态和免疫功能。结果在老年胃癌患者中存在营养风险者所占比例为81.0%(47/58);两组患者术中出血量、手术时间、术后48 h的液体引流量比较差异无统计学意义(P>0.05),患者术后的住院时间、住院费用及胃肠功能恢复时间比较差异具有统计学意义(P<0.05)。两组患者术后1周的白蛋白和前白蛋白水平比较差异具有统计学意义(P<0.05)。EN组治疗1周后CD3+T细胞、CD4+T细胞、CD4+/CD8+均较治疗前升高(P<0.01),治疗后与PN组相比,CD4+T细胞、CD4+/CD8+上升更明显(P<0.01),而CD8+T细胞下降(P<0.05)。NN组在术后l周后白蛋白及前白蛋白与术前比较无明显变化(P>0.05)。NN组在治疗l周后白蛋白及前白蛋白与术前比较无明显变化(P>0.05)。结论 NRS2002评分对于指导老年胃癌患者营养治疗具有一定效果。老年胃癌患者围手术期的营养评估对指导营养治疗具有一定意义。早期肠内营养可以促进老年胃癌患者营养状态和免疫功能的恢复,缩短住院时间。Objective To evaluate perioperative nutritional status of the elderly patients with gastric cancer, provide the basis for nutritional support, and to observe the clinical value of early postoperative enteral nutrition. Methods Select 58 cases of elderly patients with gastric cancer from April 2014 to March 2015 in our hospital as the research object. the application of nutritional risk screening 2002 （ NRS2002） was applied in nutrition assessment and 10 patients below 3 points were not performed with nutritional sup-port therapy （ NN） . 48 patients with nutritional risk were randomly divided into early enteral nutrition （ EN） and parenteral nutrition （ PN） group. 23 cases of EN group inserted nasointestinal tube and gave early enteral nutrition therapy; 25 cases of TPN group gave parenteral nutrition therapy. Clinical signs, gastrointestinal function and postoperative complications, nutritional status and immune function were compared between two groups. Results Patients with nutritional risk was shown in 81.0% （47/58） elderly patients with gastric cancer. There was no statistical difference （ P〉0.05） between two groups in intraoperative blood loss, operative time, postopera-tive 48 h liquid. Postoperative hospital stay, hospital expenses and gastrointestinal function recovery time were statistically different （ P〈0.05） . There was statistical difference（ P〈0.05） in level of ALB and PA between two groups after postoperative 1 week. CD3^＋, CD4^＋, CD4^＋/CD8＋ of EN group after One week were higher （ P〈0. 01） than before treatment. Compared with PN group, CD4^＋, CD4^＋/CD8＋ rised more obvious （ P〈0.01） , while CD8＋drop difference was statistically significant （ P〈0.05） . NN groups l weeks after surgery compared with preoperative albumin and albumin has no obvious change （ P〉0.05） . There was no statistical difference （ P〉0.05） of albumin and prealbumin in NN group after treatment for l weeks than before. Conclusion It is effective to g

关 键 词：老年胃癌 围手术期营养评估 早期肠内营养 营养支持 

分 类 号：R735.2[医药卫生—肿瘤]