优化肠内外序贯营养治疗在膀胱全切回肠代膀胱术围术期的应用研究  

Study on the application of enteral and parenteral nutrition with sequential therapy in the perioperative period of radical cystectomy and ileum replacement of bladder

作　　者：白倩 黄陈 冯筱青 杜珊珊 王建 BAI Qian;HUANG Chen;FENG Xiaoqing;DU Shanshan;WANG Jian(Department of Nutrition,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院营养科,重庆400037

出　　处：《重庆医学》2021年第19期3356-3359,3364,共5页Chongqing medicine

摘　　要：目的探讨围术期肠内外序贯营养治疗对膀胱全切回肠代膀胱术患者临床预后的影响及临床效果观察。方法57例行膀胱全切回肠代膀胱术的膀胱癌患者根据围术期营养支持方式不同分为2组。观察组27例,接受优化的围术期序贯营养治疗;对照组30例,采用本院常规围术期营养治疗。比较两组患者术后的一般情况、肝脏功能、营养状况、临床并发症、住院总费用及日均营养费用。结果除观察组碱性磷酸酶水平,两组患者手术前后肝脏功能指标变化差异无统计学意义(P>0.05)。观察组术后维生素A结合蛋白[(31.26±10.16)mg/L vs.(24.83±8.48)mg/L,P=0.012]、清蛋白[(39.53±4.11)g/L vs.(38.55±5.62)g/L,P=0.035]及前清蛋白[(158.44±41.67)g/L vs.(130.40±44.04)g/L,P=0.017]均高于对照组,差异有统计学意义。观察组并发症发生率明显低于对照组(χ^(2)=4.041,P=0.044)。观察组日均营养费用高于对照组[(220.05±77.08)元vs.(171.93±88.73)元,P=0.034],而住院总费用[(9.20±1.66)万元vs.(10.19±1.97)万元,P=0.046]及住院时间[(18.22±2.99)d vs.(20.67±5.58)d,P=0.047]较对照组降低,差异有统计学意义。结论膀胱全切回肠代膀胱术患者围术期的优化肠内外序贯营养治疗是安全、合理、有效的营养治疗方式,在改善患者临床预后、降低并发症发生率方面优于常规围术期营养支持。Objective To investigate the effect of enteral and parenteral nutrition with sequential therapy in perioperative period on the clinical prognosis of patients with radical cystectomy and ileum replacement.Methods A total of 57 patients with bladder cancer undergoing radical cystectomy and ileum replacement were divided into two groups according to different nutritional therapy during the perioperative period.The observation group of 27 cases received the perioperative sequential nutritional therapy,while the control group of 30 cases received the traditional perioperative nutritional therapy.The general condition,liver function,nutritional status,clinical complications,total hospitalization cost and average daily nutritional cost were compared between the two groups.Results There was no statistically significant difference in the liver function indexes between the two groups before and after surgery(P>0.05).The retinol binding protein[(31.26±10.16)mg/L vs.(24.83±8.48)mg/L,P=0.012],albumin[(39.53±4.11)g/L vs.(38.55±5.62)g/L,P=0.035]and prealbumin[(158.44±41.67)g/L vs.(130.40±44.04)g/L,P=0.017]in the observation group were higher than those in the control group,and the differences were statistically significant.The incidence of complications in the observation group was significantly lower than that in the control group(χ^(2)=4.041,P=0.044).The average daily nutrition cost of the observation group was significantly higher than that of the control group[(220.05±77.08)yuan vs.(171.93±88.73)yuan,P=0.034],while the total hospitalization cost[(9.20±1.66)thousand yuan vs.(10.19±1.97)thousand yuan,P=0.046]and the average length of hospitalization[(18.22±2.99)d vs.(20.67±5.58)d,P=0.047]were significantly lower than those of the control group,and the differences were statistically significant.Conclusion The enteral and parenteral nutritional with the sequential therapy for radical cystectomy and ileum replacement is a safe,reasonable,and effective nutritional therapy method in the perioperative period,which is s

关 键 词：膀胱癌 回肠代膀胱术 围手术期 序贯营养治疗 

分 类 号：R459.3[医药卫生—治疗学]