胃癌患者术后八珍汤辅助肠内营养的经济学意义

摘要

目的 观察胃癌患者术后使用中药八珍汤辅助肠内营养对住院天数、肠内营养管喂天数、营养支持费用、住院药品费用比例、住院总费用的影响.方法 采用前瞻性、随机、单盲、对照研究,将88例胃癌手术患者按抽签法随机分为对照组(肠外营养组,n =27)、A组(肠内营养组,n=30)和B组(八珍汤辅助肠内营养组,n=31).B组术后第2天开始经鼻饲管给予中药八珍汤100 ml；A、B组患者手术后第2天开始给予等热量、等氮肠内营养支持至脱离管喂；对照组术后给予等热量、等氮肠外营养支持.观察三组患者在住院天数、肠内营养管喂天数、营养支持费用、住院药品费用比例、住院总费用的情况.结果 A、B两组住院天数[(18±4)d、(17±3)d]较对照组(20±5)d降低,差异有统计学意义(P＜0.05)；且B组较A组降低更明显,差异有统计学意义(P＜0.05)；B组肠内营养管喂天数(14±2)d较A组(11±2)d降低,差异有统计学意义(P＜0.05).A、B两组营养支持费用[(5064±362)元、(4 725±311)元]较对照组(5 639±613)元降低明显,差异有统计学意义(P＜0.05)；且B组较A组降低更明显,差异有统计学意义(P＜0.05).A、B两组住院药品费用比例[(51±7)％、(42±7)％]较对照组(61±6)％降低明显,差异有统计学意义(P＜0.05)；且B组较A组降低更明显,差异有统计学意义(P＜0.05).A、B两组住院总费用[(42 071±5 600)、(33 904±5 758)元]较对照组(47 984±7004)元降低明显,差异有统计学意义(P＜0.05)；且B组较A组降低更明显,差异有统计学意义(P＜0.05).结论 胃癌术后中药八珍汤辅助肠内营养能进一步改善机体营养状况和免疫功能情况；同时可以减少住院天数、肠内营养管喂天数,降低营养支持费用、住院药品费用比例、住院总费用,有着积极的经济学意义.%Objective To observe the influence of postoperative application of enteral nutrition (EN) with accessory Bazhen Decoction on hospitalization days, tube feeding duration of enteral nutrition, nutritional support costs, hospitalization drug cost ratio and total hospitalization costs in patients with gastric cancer after operation. Methods In this prospective, randomly , single blinded, controlled clinical trial 88 patients with gastric cancer were randomly divided into three groups: control group ( parenteral nutrition, PEN, n = 27 ) , study group A ( EN, n = 30) and study group B ( Bazhen Decoction and EN, n = 31). The patients in group A and B were given isocaloric and isonitrogonous enteral nutrition via naso - gastric tube, and those in group B were administered . additional Bazhen Decoction ( 100 ml) from the second post - operation day to the day without naso gastric tube. The patients in the control group were given isocaloric and isonitrogonous parenteral nutrition. The hospitalization days, tube feeding duration of enteral nutrition, nutritional support costs, hospitalization drug cost ratio and total hospitalization costs were observed for all the patients. Results The number of hospitalization days was ( 18 ±4) in group A and ( 17 ± 3 ) in group B, being less than ( 20 ± 5 ) in the control group ( P < 0. 05 ) , and the number in group B was less than that in group A ( P < 0. 05 ) . The number of tube feeding days of enteral nutrition was ( 14 ± 2 ) in group B, being less than (11 ± 2 ) in group A (P < 0. 05). The nutritional support cost was RMB (5 064 ± 362 ) yuan in group A and ( 4 725 ±311) in group B, being lower than (5 639 ±613) in the control group (P <0. 05) , and the cost in group B was less than that in group A (P < 0. 05 ) . The hospitalization drug cost ration was (51 ±7)% in group A and (42 ± 7 ) % in group B, being lower than (61 ± 6 ) % in the control group ( P < 0. 05 ) , and the cost ratio in group B was less than that in group A ( P < 0. 05 ) . The total hospitalization cost was RMB (42 071 ±5 600) in group A and (33 904 ±5 758) in group B, being significantly lower that (47 984 ± 7 004 ) yuan in the control group ( P < 0. 05 ) , and the cost in group B was less than that in group A ( P < 0. 05 ) . Conclusion The enteral nutrition (EN) with accessory Bazhen Decoction can positively improve the cellular immune function and nutritional status in patients with gastric cancer after operation, and can also reduce the hospitalization days and the tube feeding duration of enteral nutrition, decrease the nutritional support costs, hospitalization drug cost ratio and total hospitalization costs. Thereby it has a positive significance in economics.