加速康复外科背景下的早期肠内营养与肠外营养对有营养风险胃癌患者术后临床结局的影响  

Effect of early enteral nutrition and parenteral nutrition on the postoperative outcomes of patients with gastric cancer and nutritional riskin enhanced recovery after surgery

作　　者：蔡泽君 谢浩芬[2] 徐琴鸿[2] 李益萍[1] 严志龙[1] 汪慧访[1] 姜建帅[1] Cai Zejun;Xie Haofen;Xu Qinhong;Li Yiping;Yan Zhilong;Wang Huifang;Jiang Jianshuai(Department of Surgery,Ningbo First Hospital,Ningbo 315010,Zhejiang,China)

机构地区：[1]宁波市第一医院外科,315010 [2]宁波市第一医院护理部,315010

出　　处：《中华临床营养杂志》2019年第5期281-286,共6页Chinese Journal of Clinical Nutrition

基　　金：宁波市医学科技计划项目(2011A03);浙江省医学科技计划项目(2017KY587)。

摘　　要：目的探讨在加速康复外科背景下早期肠内营养(E E N)与肠外营养(PN)对有营养风险胃癌术后患者的临床结局的影响。方法选择2016年9月至2018年5月在宁波市第一医院胃肠外科住院胃癌患者130例,随机分为EEN组与P N组。两组均实施加速康复外科措施。EEN组在术中放置空肠营养管,术后12~24 h给予肠内营养。P N组术后第1天开始给予肠外营养支持。两组患者给予等热量、等氮的营养素。比较两组营养相关并发症的发生率、感染相关并发症的发生率、术后住院天数及肛门排气时间。结果E E N组发生营养相关并发症10例(15.38%),P N组为4例(6.15%),两组比较差异无统计学意义(P=0.157)。EEN组发生感染并发症例数为3例(4.61%)与PN组感染并发症发生例数5例(7.69%)相比,差异无统计学意义(P=0.715);EEN组术后住院天数11(10~15)d与P N组12(11~13)d相比,差异无统计学意义(P=0.233)。EEN组首次肛门排气64(52~77)h及排便时间87(76~100)h较P N组排气时间72(60~86)h、排便时间96(86~120)h提前,差异有统计学意义(P=0.001,P=0.034)。结论在加速康复外科背景下,胃癌术后早期肠内营养可促进术后肠道功能恢复,但并发症发生率和术后住院时间无明显改善。Objective To explore the effect of early enteral nutrition(EEN)and parenteral nutrition(PN)on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery.Methods A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group(EEN)which was placed with jejunal nutrition tube during the operation,and enteral nutrition started within 12-24 hours after the operation,and parenteral nutrition support group(PN)which was given parenteral nutrition support one day after surgery.Patients in both groups were given nutrients of equal heat and nitrogen.The incidence of nutrition-related complications,the incidence of infection-related complications,the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups.Results The incidence of nutrition-related complications was 10 cases(15.38%)and 4 cases(6.15%)in EEN group and PN group,that was not statistically different(P=0.157).The incidence of infection-related complications was 3 cases(4.61%)and 5 cases(7.69%)in EEN group and PN group,that was not statistically different(P=0.715).The postoperative hospital stay was 11 days(range,10-15)and 12 days(range,11-13)in EEN group and PN group,that was not statistically different(P=0.233).The first anal exhaust time and defecation timewere 64 hours(range,52-77)and 87 hours(range,76-100)in EEN group and 72 hours(range,60-86)and%hours(range,86-120)in PN group,that was statistically different(P=0.001,P=0.034).Conclusion Enhanced recovery after surgery,early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function,but the complications and hospital stay after operation are not improved.

关 键 词：加速康复外科 早期肠内营养 肠外营养 胃癌 

分 类 号：R73[医药卫生—肿瘤]