中国临床营养杂志
中國臨床營養雜誌
중국림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2001年
2期
133
,共1页
目的评价全胃切除术后早期管饲的安全性,比较术后短期管饲与标准肠外营养支持的疗效。方法对我院1998年1月~2000年1月20例全胃切除术后病人随机分为管饲营养组和肠外营养组,试验周期为术后7天。全部病人均为全胃切除空肠p型代胃,食管空肠吻合口距远端空肠吻合口为40cm,鼻肠管放置于远端空肠吻合口以下。管饲营养组术后第2天开始管饲,第1次滴入生理盐水500ml,4小时后滴入安素250ml(250kcal),再4小时后滴入安素250ml(250kcal),速度均为40~50ml/h。以后每日分为三次,间隔3~4小时。术后第3天,滴入安素750~1000ml(750~1000kcal),速度为60~80ml/h。第4~7天,滴入安素1500~1750ml(1500~1750kcal),速度为100~120ml/h。肠外营养组能量25~30kcal*kg-1*d-1供给。检测体重、机体测量指标、水电解质变化(包括出入量、尿比重、尿糖、尿丙酮、血清电解质、血糖)、血红蛋白、血清总蛋白、白蛋白、血清尿素氮、肌酐、血清总胆固醇、血清甘油三脂和外周血淋巴细胞。结果本组病例均未发生吻合口瘘,管饲营养组和肠外营养组在体重、机体测量指标、血浆蛋白浓度、氮平衡指标、外周血淋巴细胞均无显著差异。讨论全胃切除术后早期管饲营养的方法安全有效,管饲营养与肠外营养效果基本相近。管饲营养密切观察护理,及时调节滴入速度,不会引起误吸、恶心、呕吐、腹泻、低蛋白血症和电解质紊乱的症状发生。费用低,适合于基层医院开展。
目的評價全胃切除術後早期管飼的安全性,比較術後短期管飼與標準腸外營養支持的療效。方法對我院1998年1月~2000年1月20例全胃切除術後病人隨機分為管飼營養組和腸外營養組,試驗週期為術後7天。全部病人均為全胃切除空腸p型代胃,食管空腸吻閤口距遠耑空腸吻閤口為40cm,鼻腸管放置于遠耑空腸吻閤口以下。管飼營養組術後第2天開始管飼,第1次滴入生理鹽水500ml,4小時後滴入安素250ml(250kcal),再4小時後滴入安素250ml(250kcal),速度均為40~50ml/h。以後每日分為三次,間隔3~4小時。術後第3天,滴入安素750~1000ml(750~1000kcal),速度為60~80ml/h。第4~7天,滴入安素1500~1750ml(1500~1750kcal),速度為100~120ml/h。腸外營養組能量25~30kcal*kg-1*d-1供給。檢測體重、機體測量指標、水電解質變化(包括齣入量、尿比重、尿糖、尿丙酮、血清電解質、血糖)、血紅蛋白、血清總蛋白、白蛋白、血清尿素氮、肌酐、血清總膽固醇、血清甘油三脂和外週血淋巴細胞。結果本組病例均未髮生吻閤口瘺,管飼營養組和腸外營養組在體重、機體測量指標、血漿蛋白濃度、氮平衡指標、外週血淋巴細胞均無顯著差異。討論全胃切除術後早期管飼營養的方法安全有效,管飼營養與腸外營養效果基本相近。管飼營養密切觀察護理,及時調節滴入速度,不會引起誤吸、噁心、嘔吐、腹瀉、低蛋白血癥和電解質紊亂的癥狀髮生。費用低,適閤于基層醫院開展。
목적평개전위절제술후조기관사적안전성,비교술후단기관사여표준장외영양지지적료효。방법대아원1998년1월~2000년1월20례전위절제술후병인수궤분위관사영양조화장외영양조,시험주기위술후7천。전부병인균위전위절제공장p형대위,식관공장문합구거원단공장문합구위40cm,비장관방치우원단공장문합구이하。관사영양조술후제2천개시관사,제1차적입생리염수500ml,4소시후적입안소250ml(250kcal),재4소시후적입안소250ml(250kcal),속도균위40~50ml/h。이후매일분위삼차,간격3~4소시。술후제3천,적입안소750~1000ml(750~1000kcal),속도위60~80ml/h。제4~7천,적입안소1500~1750ml(1500~1750kcal),속도위100~120ml/h。장외영양조능량25~30kcal*kg-1*d-1공급。검측체중、궤체측량지표、수전해질변화(포괄출입량、뇨비중、뇨당、뇨병동、혈청전해질、혈당)、혈홍단백、혈청총단백、백단백、혈청뇨소담、기항、혈청총담고순、혈청감유삼지화외주혈림파세포。결과본조병례균미발생문합구루,관사영양조화장외영양조재체중、궤체측량지표、혈장단백농도、담평형지표、외주혈림파세포균무현저차이。토론전위절제술후조기관사영양적방법안전유효,관사영양여장외영양효과기본상근。관사영양밀절관찰호리,급시조절적입속도,불회인기오흡、악심、구토、복사、저단백혈증화전해질문란적증상발생。비용저,괄합우기층의원개전。
Objective To evaluate the safety and effect of early enteralnutrition support in patients undergoing total gastrectomy. Methods 30 patients undergoing total gastrectomy were randomized into two groups:study group (PN and early EN),control group (PN).Patients in study group received enteral feeding from 24 hours after operation starting with normal saline.Insure was given in 4 hours with the rate of 40-50ml/h, and the amount of Insure increased gradually till EN became the only nutrition support way on the 3rd postoperative day.The nutrition support formula was isocaloric (30kcal/kg/day) and isonitrogenic(0.15g/kg/day)between the two groups.Body weight,anthropometry,nitrogen balance,hemoglobin,plasma albumin,and lymphocyte count was evaluated on the 7th postoperative day. Result There were no significant defference in body weight,anthropometry,nitrogen balance,hemoglobin,plasma albumin,and lymphocyte count between two groups. Conclusion Enteral nutrition in the early period after abdominal surgery is safe and effective.Enteral feeding is suitable to primary level hospitals because of low cost.