食管癌术后早期肠内营养联合肠外营养与全肠外营养支持的临床疗效比较  

Effect comparison of combined application of enteral nutrition and parenteral nutrition with TPN in patients after esophageal cancer surgery

作　　者：龙晓静[1] 孙德强[2] 曾英[1] 文秀玉[1] 江涛[1] 

机构地区：[1]广西中医药大学第一附属医院营养科,广西南宁530023 [2]新疆维吾尔自治区人民医院临床营养研究所,新疆乌鲁木齐830001

出　　处：《中国医药导报》2016年第5期126-129,共4页China Medical Herald

摘　　要：目的探讨早期肠内营养（EEN）联合肠外营养（PN）与全肠外营养（TPN）支持对食管癌患者临床疗效、不良反应的差异。方法选取广西中医药大学第一附属医院2011年2月~2013年10月收治的80例食管癌患者为研究对象,患者均成功行食管癌切除管状胃代食管术,按照随机数字表法为EEN＋PN组和TPN组,每组各40例。TPN组术后行TPN支持治疗,EEN＋PN组术后行早期给予EEN联合PN支持。观察患者肛门排气时间、排便时间、术后住院时间、住院费用等情况。并于术前、术后3、7 d进行生化指标检测;同时记录患者住院期间的不良反应及并发症,比较两种方案的疗效。结果 1术后3 d两组患者各指标均有不同程度的降低,术后7 d又有回升;组内比较,EEN＋PN组除免疫球蛋白A（Ig A）,其他指标治疗前后差异有统计学意义（P〈0.05）;TPN组除免疫球蛋白M（Ig M）和Ig A,其他指标治疗前后差异有统计学意义（P〈0.05）。组间比较,术后EEN＋PN组淋巴细胞计数（LYM）、前白蛋白（PAB）、免疫球蛋白G（Ig G）、Ig M改善程度显著优于TPN组,差异有统计学意义（P〈0.05）,血清白蛋白（ALB）和Ig A差异无统计学意义（P〉0.05）。2术后EEN＋PN组患者肛门排气时间、排便时间、住院时间均较TPN组明显缩短,营养支持费用也显著少于TPN组,差异有高度统计学意义（P〈0.01）。3EEN＋PN组并发症发生率为10.0%,TPN组并发症发生率为17.5%,差异无统计学意义（P〉0.05）。结论食管癌患者术后早期肠内营养联合肠外营养与全肠外营养支持相比,前者有利于患者恢复肠道功能和免疫功能,缩短住院时间,而且价格低廉,值得推广应用。Objective To compare the clinical value of the combined application of early enteral nutrition（EEN） and parenteral nutrition（PN） with total parenteral nutrition（TPN） in esophageal cancer patients undergoing radical resection. Methods From February 2011 to October 2013, in the First Affiliated Hospital of Guangxi traditional Chinese Medicine University, 80 patients with esophageal cancer surgery were selected as objects in this study, accoding to random number table, they were divided into EEN＋PN group and TPN group, with 40 cases in each group. Patients in TPN group were given TPN, patients in EEN ＋PN group were given EEN and PN. The anal exhaust time, defecation time, postoperative hospital stay, hospitalization expenses were observed, the biochemical parameters and serum immune globulin were detected before and after operation, the adverse reactions and complications were recorded, effect of two schemes were compared. Results 1 After the surgery 3 d, the indexes of patients in two groups decreased, and after the surgery 7 d, indexes recovered. In EEN＋PN group, the indexes except Ig A before and after the surgery were compared, the differences were statistically significant（P〈0.05）; in TPN group, except Ig M and Ig A, the indexes before and after the surgery were compared, the differences were statistically significant（P〈0.05）. LYM, PAB, Ig G, Ig M in EEN＋PN group was significantly better than those in TPN group, the differences were statistically significant（P〈0.05）, ALB and Ig A in two groups were compared, the differences were not statistically significant（P〈0.05）. 2 The anal exhaust time, defecation time, hospitalization time of EEN＋PN group were significantly shorter than those in the TPN group, and the nutritional support was also significantly less than that of the TPN group, the differences were statistically significant（P〈0.01）. 3 The complication rate of EEN＋PN group was 10%, while TPN group was 17.5%, the difference was not statistically significan

关 键 词：早期肠内营养 全肠外营养 食管癌 

分 类 号：R735.1[医药卫生—肿瘤]