早期经鼻肠管持续滴注肠内营养对胃癌术后近期营养状态及机体组成的影响

摘要

Objective To investigate the effect of the early postoperative enteral nutrition on nutrition status and body composition in patients with gastric cancer after gastrectomy. Methods Thirty one patients with gastric cancer were divided into two group: treatment group which received early enteral nutrition( n = 16 ), and control group which received parenteral nutrition( n = 15 ). The patients in treatment groups received enteral nutrition as follows: peptisorb liquid ( Nutricia ) 500 ml on postoperative day 1st, 1000 ml on postoperative day 2nd and 1500 ml from postoperative day 3rd to day 10th. The patients in control group received parenteral nutrition as follows: TPN from postoperative day 1st to day 3rd, PN added with independent eating from postoperative day 4th to day 7th and independent eating after 7 days. The level of Alb,pre Alb and body compositions were detected 10 days after operation. Results The nutritive index in each group were decreased compared with pre-operation status, the differences between the two groups were not statistical significant P >0. 05 ). The body weight and FFM in the control group were decreased more obvious( P <0.05 ). The gastrointestinal symptoms score between two groups were statistical different P <0. 05 ). There were no statistical differences in complications between the two groups( P >0.05 ). Conclusion The early postoperative enteral nutrition improved the nutritional status and the composition of the body.%目的 探讨早期鼻饲肠内营养对胃癌术后近期营养状态及机体组成的影响.方法 选择择期手术胃窦癌患者31例,手术方式均为远端根治性胃大部分切除(毕II式吻合,无远处转移及种植),随机分为治疗组(16例)和对照组(15例).治疗组于术后24 h后开始经鼻饲空肠营养(百普力),第1天输注500 ml,第2天开始加至1000 ml,第3天1500 ml,连续使用至术后第10天.对照组术后3 d完全周围静脉营养(热量25 kcal·kg-1·d-1,糖脂比6∶4,氮热比1∶120).术后第4天予以半量静脉营养,不足部分依靠患者自主进食,术后第7天,停用营养支持,完全依赖自主进食.分别于术前、术后第10天检测血清白蛋白、前白蛋白、体质量及机体组成[脂肪群(FM)、非脂肪群(FFM)].结果 2组术后前白蛋白、白蛋白均较术前明显下降,2组间比较差异无统计学意义(P>0.05);2组术后体质量、FM、FFM均较治疗前下降(P<0.05),对照组患者术后体质量、FFM下降较治疗组更加明显(P＜0.05),而FM下降2组之间比较差异无统计学意义(P>0.05);治疗组术后食欲、饮食量、餐后饱胀评分较对照组更佳(P＜0.05),而灼心感、呕吐、腹泻差异无统计学意义(P>0.05);术后并发症2组间比较差异无统计学意义(P>0.05).结论 胃癌术后早期被动的经鼻肠管持续滴注肠内营养可明显改善机体营养状况及机体组成.