中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
11期
1063-1066
,共4页
刘昭晖%苏国强%张思宇%张景斌%黄小蓉
劉昭暉%囌國彊%張思宇%張景斌%黃小蓉
류소휘%소국강%장사우%장경빈%황소용
胃肿瘤%老年人%术后早期营养支持%肠外营养%肠内营养
胃腫瘤%老年人%術後早期營養支持%腸外營養%腸內營養
위종류%노년인%술후조기영양지지%장외영양%장내영양
Stomach neoplasms%Elderly%Early postoperative nutritional support%Parenteral nutrition%Enteric nutrition
目的 探讨老年胃癌术后合理的早期营养支持方式.方法 前瞻性入组2010年1月至2013年3月间厦门大学附属第一医院收治的120例老年胃癌术后患者,按随机数字表法分为完全肠外营养组(TPN)、完全肠内营养组(TEN)及部分肠内加肠外营养组(EN加PN),每组40例.比较3组患者营养支持治疗耐受性、术后7d营养指标和免疫指标、术后肛门排气时间及感染并发症发生率.结果 在营养支持过程中,EN加PN组耐受性(97.5％,39/40)明显高于TPN组(82.5％,33/40)和TEN组(80.0％,32/40)(P＜0.05).术后7d,3组患者体质量指数、血浆白蛋白、前白蛋白及转铁蛋白水平等营养指标的差异均无统计学意义(P＞0.05);但EN加PN组和TEN组CD3、CD4、CD4/CD8等免疫指标明显高于TPN组(均P＜0.05).EN加PN组和TEN组感染发生率明显低于TPN组[5.13％(2/39)和6.25％(2/32)比12.12％(4/33),P＜0.05],肛门排气时间明显快于TPN组[(49.5±22.1)h和(48.2±17.6)h比(68.2±16.7)h,P＜0.05].结论 老年胃癌术后早期行肠内营养安全可行,EN加PN为最佳的早期营养支持方式.
目的 探討老年胃癌術後閤理的早期營養支持方式.方法 前瞻性入組2010年1月至2013年3月間廈門大學附屬第一醫院收治的120例老年胃癌術後患者,按隨機數字錶法分為完全腸外營養組(TPN)、完全腸內營養組(TEN)及部分腸內加腸外營養組(EN加PN),每組40例.比較3組患者營養支持治療耐受性、術後7d營養指標和免疫指標、術後肛門排氣時間及感染併髮癥髮生率.結果 在營養支持過程中,EN加PN組耐受性(97.5％,39/40)明顯高于TPN組(82.5％,33/40)和TEN組(80.0％,32/40)(P＜0.05).術後7d,3組患者體質量指數、血漿白蛋白、前白蛋白及轉鐵蛋白水平等營養指標的差異均無統計學意義(P＞0.05);但EN加PN組和TEN組CD3、CD4、CD4/CD8等免疫指標明顯高于TPN組(均P＜0.05).EN加PN組和TEN組感染髮生率明顯低于TPN組[5.13％(2/39)和6.25％(2/32)比12.12％(4/33),P＜0.05],肛門排氣時間明顯快于TPN組[(49.5±22.1)h和(48.2±17.6)h比(68.2±16.7)h,P＜0.05].結論 老年胃癌術後早期行腸內營養安全可行,EN加PN為最佳的早期營養支持方式.
목적 탐토노년위암술후합리적조기영양지지방식.방법 전첨성입조2010년1월지2013년3월간하문대학부속제일의원수치적120례노년위암술후환자,안수궤수자표법분위완전장외영양조(TPN)、완전장내영양조(TEN)급부분장내가장외영양조(EN가PN),매조40례.비교3조환자영양지지치료내수성、술후7d영양지표화면역지표、술후항문배기시간급감염병발증발생솔.결과 재영양지지과정중,EN가PN조내수성(97.5％,39/40)명현고우TPN조(82.5％,33/40)화TEN조(80.0％,32/40)(P＜0.05).술후7d,3조환자체질량지수、혈장백단백、전백단백급전철단백수평등영양지표적차이균무통계학의의(P＞0.05);단EN가PN조화TEN조CD3、CD4、CD4/CD8등면역지표명현고우TPN조(균P＜0.05).EN가PN조화TEN조감염발생솔명현저우TPN조[5.13％(2/39)화6.25％(2/32)비12.12％(4/33),P＜0.05],항문배기시간명현쾌우TPN조[(49.5±22.1)h화(48.2±17.6)h비(68.2±16.7)h,P＜0.05].결론 노년위암술후조기행장내영양안전가행,EN가PN위최가적조기영양지지방식.
Objective To explore the optimal postoperative nutritional support in elderly patients with gastric cancer.Methods One hundred and twenty elderly patients with gastric cancer undergoing radical gastrectomy were prospectively enrolled from January 2010 to March 2013 and randomly divided into total parenteral nutrition group(TPN,n=40),early total enteral nutrition group (TEN,n=40) and enteral plus parenteral nutrition group (EN+PN,n=40).Clinical charasteristics including treatment tolerance,nutritional indexes,immune indexes,time to first flatus,incidence of postoperative infection and anastomotic leakage,were analyzed and compared.Results Treatment tolerance in EN+PN group(97.5％,39/40) was significantly higher than that in TPN group (82.5％,33/ 40) and TEN group (80.0％,32/40) (both P＜0.05).The nutritional indices,including prealbumin,albumin,transferrin,body mass index,and the incidence of anastomotic leakage were similar in the 3 groups (P＞0.05).The immune indices,including CD3,CD4,CD4/CD8,were significantly reduced after operation in each group.However,they were significantly higher in EN +PN group and TEN group than those in TPN group (both P＜0.05).Furthermore,compared to the TPN group,the incidence of postoperative infection (surgical site infection,pulmonary infection,abdominal infection) was significantly lower and time to first flatus was significantly shorter in EN+PN group and TEN group.Conclusions Early enteral nutrition after gastric cancer surgery is safe,simple and feasible.EN plus PN is the best way to administer postoperative nutritional support in elderly patients with gastric cancer.
