早期肠内营养在上消化道肿瘤术后的应用

摘要

目的 观察上消化道肿瘤术后采用早期肠内营养(early enteral nutrition,EEN)对患者进行营养支持的安全性、有效性及可行性.方法 2007年1月-2008年6月对上消化道肿瘤患者45例于术后24h经鼻营养管注入要素饮食,同期对比35例按传统肠外营养进行术后营养支持,观察术前第1天及术后第6天2组血清白蛋白(serum albumin,ALB)、前白蛋白(prealbumin,PA);术后第1次胃肠道排气时间;EEN过程中相关并发症及术后并发症发生.结果 EEN组治疗的上消化道肿瘤患者术前第1天ALB平均为(31.1±4.1)g/L,肠外营养组治疗的上消化道肿瘤患者术后第1天ALB平均为(30.1±3.7)g/L,其差异无统计学意义(P＞0.05).而术后EEN组第6天ALB平均为(29.2±4.5)g/L,肠外营养组第6天ALB平均为(25.8±4.9)g/L,差异有统计学意义(P＜0.05).2组术后第1次胃肠排气时间差异有统计学意义(P＜0.05).EEN过程中相关并发症主要表现为腹胀、恶心,未见其他严重并发症.2组术后并发症差异有统计学意义(P＜0.05).结论 EEN在上消化道肿瘤术后应用是安全、可靠的,可促进患者术后早期胃肠道功能恢复,保护肠黏膜正常吸收、消化功能,减少术后患者输液负荷.%Objective To observe the effects and evaluate the reliability and feasibility of early enteral nutrition in the postoperative patients with upper digestive tract cancer. Methods The clinical data of 45 patients with upper digestive tract cancer from January 2007 to July 2008, who received elemental diet through enteral nasojejunal feeding tube 24 hours after the operation were retrospectively analyzed. At the same time,35 cases who received traditional parenteral nutrition were selected as control. The nutrition parameters including serum albumin (ALB), prealbumin(PA) were measured on the day before operation and the sixth day after operation respectively. The time of exhaust and the subsequent complications were also observed. Results There was no significant difference in the ALB between the two groups: the average ALB in the patients with early postoperative enteral nutrition support on the day before operation was (31. 1±4. 1)g/L, while the average ALB in the patients with parenteral nutrition was (30. 1±3. 7)g/L. There was no significant difference between the two groups(P>0. 05). But on the sixth postoperative day, the the average ALB in the patients with early postoperative enteral nutrition support fell to (29. 2±4. 5)g/L, while the average ALB in the patients with parenteral nutrition fell to (25. 8±4. 9)g/L with significant difference between the two groups(P<0. 05). There were significant differences in the time of exhaust and complications between the two groups as well. The main complications of enteral nutrition were abdominal distension and nausea(5 cases, 15%). Conclusion The early enteral nutrition is safe and effective. Application of early enteral nutrition in patients with upper digestive tract cancer not only could improve the recovery of gastrointestinal function, but also protect the mucosal absorption and the digestive function.