早期肠内营养对食管癌根治术后患者预后影响的研究  

Research on the impact of early prognosis of postoperation enteral nutrition supportive therapy in patients with radical surgery for esophageal cencer

作　　者：林红兰 任艳军 杨文超[1] 惠欣欣 贺书 成晓丽 罗敏[1] Lin Honglan;Ren Yanjun;Yang Wenchao(Thoracic Surgery,the Third Clinical Centre,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心胸外科,北京100039

出　　处：《中华保健医学杂志》2023年第6期688-690,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的 探讨早期肠内营养对食管癌根治术后患者的临床应用价值。方法 选取解放军总医院第三医学中心2017年1月~2023年2月收治的96例行食管癌根治术患者,随机数表法将患者分为对照组和观察组,各48例。对照组患者术后常规禁食,给予肠外营养支持和相关治疗;观察组患者术后早期行肠内营养支持及相关治疗。比较两组患者术后2、4、6和8 d血白细胞计数水平变化;比较两组患者术后肠功能恢复时间和胸腔引流管拔管时间;比较两组患者并发症发生情况。通过logistic回归分析影响患者术后住院时间的相关因素。结果 观察组术后第4、6和8 d的白细胞计数均低于对照组,差异有统计学意义(t=2.520、2.128、2.087,P<0.05)。观察组患者的肠鸣音恢复、首次肛门排气、排便时间均优于对照组,差异有统计学意义(t=2.837、3.542、2.252,P<0.05);胸腔引流管拔管时间低于对照组[(4.02±0.62)d vs.(6.06±1.07)d],差异有统计学意义(t=7.286,P<0.05)。观察组吻合口瘘(3/48,6.25%),低于对照组(8/48,16.67%),差异有统计学意义(χ2=4.832,P<0.05)。观察组患者术后住院天数比对照组明显缩短,差异有统计学意义(t=3.835,P<0.05)。logistic回归分析显示,吻合口瘘、肺部感染是住院时间延长的独立危险因素(P<0.05),而早期肠内营养和更早的引流管拔除是缩短住院时间和改善患者预后的重要因素(P<0.05)。结论 食管癌根治术后患者早期肠内营养安全有效,可改善营养状态,促进肠道功能恢复,减少吻合口瘘等并发症发生率,缩短住院时间,提高患者术后近中期营养水平和生活质量,临床应用价值显著,有必要进一步深入的研究。Objective To explore the clinical application value of early postoperative enteral nutrition supportive therapy on patients with radical operation for esophageal cancer.Methods A total of 96 cases with esophageal carcinoma radical resection from January 2017 to February 2023 were used as research objects.The patients were divided into the control group and the observation group according to random method,with 48 cases in each group.Patients in the control group received the postoperative conventional fasting,Parenteral nutrion support and related care.The patients in the observation group were given early postoperative enteral nutrition supportive therapy and related intervention.The observation of the gastrointestinal function recovery(first exhaust time,first defecation time,intestinal peristalsis recovery time)and the incidence of complications were compared between the two groups.The time of chest tube drawing and length of hospital stay were also compared in two groups.The white blood cell counts were tested on the 2th,4th,6th,and 8th postoperation days.Related factors affecting postoperation by binary logistic regression analysis.Results The white blood cell counts on the 2th,4th,6th,and 8th postoperative day in the observation group were less than that in the control group(t=2.520,2.128,2.087,P<0.05).The bowel sounds recovery time,first exhaust time and first defecation time in the observation group was significantly better than that in the control group(t=2.837,3.542,2.252,P<0.05).The time of chest tube drawing in the observation group was significantly better than that in the control group[(4.02±0.62)d vs.(6.06±1.07)d](t=7.286,P<0.05).The anastomotic leakage in the observation group(348,6.25%)was significantly lower than that in the control group(848,16.67%)(χ^(2)=4.832,P<0.05).The postoperative hospitalization days in the observation group was less than that in the control group(t=3.835,P<0.05).The incidence of postoperation anastomtic leakage(OR=1.225,95%CI=1.109~1.371,P=0.011),and pulmonary infecti

关 键 词：食管癌根治术后 早期肠内营养 吻合口瘘 肠外营养 临床应用价值 

分 类 号：R735.1[医药卫生—肿瘤]