中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
9期
864-867
,共4页
柳硕岩%陈啸风%王枫%郑庆丰%王健键
柳碩巖%陳嘯風%王楓%鄭慶豐%王健鍵
류석암%진소풍%왕풍%정경봉%왕건건
食管肿瘤%糖尿病%肠内营养%肠外营养%治疗效果
食管腫瘤%糖尿病%腸內營養%腸外營養%治療效果
식관종류%당뇨병%장내영양%장외영양%치료효과
Esophageal neoplasms%Diabetes mellitus%Enteral nutrition%Parenteral nutrition%Treatment outcomes
目的 比较围手术期肠内与肠外营养支持对于合并糖尿病的食管癌患者的治疗效果.方法 前瞻性入组2012年9-11月间福建省肿瘤医院胸外科收治的30例合并糖尿病的食管癌患者,按随机数字表法将其随机分为肠内营养组(15例)和肠外营养组(15例).两组于术前3d至术后8d期间分别给予肠内营养素(安素)和肠外营养支持.每日动态监测血糖；术前1d和术后8d检测患者的营养指标(白蛋白和前白蛋白)；观察术后胃肠道功能恢复时间和营养支持相关并发症发生率;统计营养支持总费用.结果 两组患者围手术期血糖控制情况均较为满意:3餐前手指末梢血糖为5.0～9.0 mmol/L,3餐后2h手指末梢血糖为7.0～10.0 mmol/L,晚10时和凌晨3时的血糖波动于4.0～8.0 mmol/L;所有患者均未出现低血糖(末梢血糖小于3.5 mmol/L).肠内营养组术后首次排气时间为(62.4±15.7)h,明显快于肠外营养组的(90.8±22.4) h(P＜0.01).两组患者术后营养指标及营养支持相关并发症方面的差异均无统计学意义(均P＞0.05).肠内营养组营养支持费用为(650.8±45.8)元,明显低于肠外营养组的(3016.5±152.6)元(P＜0.01).结论 在合并糖尿病的食管癌患者中,围手术期营养支持能在有效调控血糖的同时明显改善其营养状况.与肠外营养相比,使用安素进行肠内营养能加快胃肠功能恢复,并降低营养支持的费用.
目的 比較圍手術期腸內與腸外營養支持對于閤併糖尿病的食管癌患者的治療效果.方法 前瞻性入組2012年9-11月間福建省腫瘤醫院胸外科收治的30例閤併糖尿病的食管癌患者,按隨機數字錶法將其隨機分為腸內營養組(15例)和腸外營養組(15例).兩組于術前3d至術後8d期間分彆給予腸內營養素(安素)和腸外營養支持.每日動態鑑測血糖；術前1d和術後8d檢測患者的營養指標(白蛋白和前白蛋白)；觀察術後胃腸道功能恢複時間和營養支持相關併髮癥髮生率;統計營養支持總費用.結果 兩組患者圍手術期血糖控製情況均較為滿意:3餐前手指末梢血糖為5.0～9.0 mmol/L,3餐後2h手指末梢血糖為7.0～10.0 mmol/L,晚10時和凌晨3時的血糖波動于4.0～8.0 mmol/L;所有患者均未齣現低血糖(末梢血糖小于3.5 mmol/L).腸內營養組術後首次排氣時間為(62.4±15.7)h,明顯快于腸外營養組的(90.8±22.4) h(P＜0.01).兩組患者術後營養指標及營養支持相關併髮癥方麵的差異均無統計學意義(均P＞0.05).腸內營養組營養支持費用為(650.8±45.8)元,明顯低于腸外營養組的(3016.5±152.6)元(P＜0.01).結論 在閤併糖尿病的食管癌患者中,圍手術期營養支持能在有效調控血糖的同時明顯改善其營養狀況.與腸外營養相比,使用安素進行腸內營養能加快胃腸功能恢複,併降低營養支持的費用.
목적 비교위수술기장내여장외영양지지대우합병당뇨병적식관암환자적치료효과.방법 전첨성입조2012년9-11월간복건성종류의원흉외과수치적30례합병당뇨병적식관암환자,안수궤수자표법장기수궤분위장내영양조(15례)화장외영양조(15례).량조우술전3d지술후8d기간분별급여장내영양소(안소)화장외영양지지.매일동태감측혈당；술전1d화술후8d검측환자적영양지표(백단백화전백단백)；관찰술후위장도공능회복시간화영양지지상관병발증발생솔;통계영양지지총비용.결과 량조환자위수술기혈당공제정황균교위만의:3찬전수지말소혈당위5.0～9.0 mmol/L,3찬후2h수지말소혈당위7.0～10.0 mmol/L,만10시화릉신3시적혈당파동우4.0～8.0 mmol/L;소유환자균미출현저혈당(말소혈당소우3.5 mmol/L).장내영양조술후수차배기시간위(62.4±15.7)h,명현쾌우장외영양조적(90.8±22.4) h(P＜0.01).량조환자술후영양지표급영양지지상관병발증방면적차이균무통계학의의(균P＞0.05).장내영양조영양지지비용위(650.8±45.8)원,명현저우장외영양조적(3016.5±152.6)원(P＜0.01).결론 재합병당뇨병적식관암환자중,위수술기영양지지능재유효조공혈당적동시명현개선기영양상황.여장외영양상비,사용안소진행장내영양능가쾌위장공능회복,병강저영양지지적비용.
Objective To compare the efficacy between perioperative enteral and parenteral nutrition support for esophageal cancer patients complicated with diabetes mellitus.Methods Thirty esophageal cancer patients complicated with diabetes mellitus between September and November 2012 were prospectively enrolled in this trial.According to random number table,30 cases were randomly divided into enteral group(n=15) and parenteral group(n=lS).During the period between 3 days before operation and 8 days after operation,patients received enteral nutrition (AnSure) and parenteral nutrition support respectively.The daily dynamic monitoring of blood glucose was performed.Nutritional indexes (albumin and prealbumin) were evaluated 1-day before operation and 8-day after operation.Postoperative recovery time of gastrointestinal function and complications associated with nutritional support were observed.The cost of nutritional support was calculated.Results Patients in the two groups achieved satisfactory perioperative blood glucose control.Finger tip blood glucose was 5.0-9.0 mmol/L before meal,7.0-10.0 mmol/L 2-hour after meal,and 4.0-8.0 mmol/L at 10 PM and 3 AM.No hypoglycemia (＜3.5 mmol/L) was found in all the patients.The time to first flatus after surgery was (62.4±15.7) in the enteral group,significantly earlier than (90.8±22.4) h in the parenteral group (P＜0.01).Postoperative nutritional indices and associated complications were not significantly different between two groups(all P＞ 0.05).Cost in the enteral group was significantly lower than that in the parenteral group [(650.8±45.8) RMB vs.(3016.5±152.6) RMB,P＜0.01].Conclusion Perioperative nutrition support can effectively control blood glucose and improve perioperative nutritional status simultaneously for esophageal cancer patients with diabetes mellitus.Compared with parenteral nutrition,enteral nutrition can accelerate the recovery of gastric bowel function and reduce the cost of nutritional support.
