CAJ | 학술논문

目的：评价低氮低热量肠外营养对食管癌术后营养状态、血糖和术后并发症的影响。方法：2012年1月-2013年12月，将60例符合标准的食管癌患者按照1：1的比例随机分为低氮低热量组（研究组）和传统氮热量组（对照组），每组30例，均行开胸食管癌切除胸内吻合术。术后前5 d采用全肠外营养支持治疗，研究组按热量20 kCal/（kg·d），氮0.1 g/（kg·d）给予，对照组按热量35 kCal/（kg·d），氮0.2 g/（kg·d）给予。术后观察并记录患者并发症的发生率。术前1d、术后第3、6天测定血浆总蛋白、白蛋白、前白蛋白，术前和术后第1、3、6天查动脉血气测PaO2、PaCO2、乳酸浓度等指标，并在输注肠外营养开始后3 h测末梢血糖。结果：术后第3天和术后第6天两组各蛋白指标均较术前有所降低，但是差异无统计学意义（P>0.05）；研究组术后第1、3、6天的PaO2显著高对照组（P<0.05）；研究组术后PaCO2、乳酸和末梢血糖要显著低于对照组（P<0.05）。研究组术后心律失常、肺部感染、刀口感染和吻合口瘘的发生率比较差异无统计学意义（P>0.05）；研究组术后总的并发症发生率显著低于对照组（P<0.05）。结论：食管癌术后低氮低热量肠外营养与传统氮热量相比营养状态相似，但能更好控制术后血糖水平，有利于降低肺损伤及降低总的并发症发生率。
목적：평개저담저열량장외영양대식관암술후영양상태、혈당화술후병발증적영향。방법：2012년1월-2013년12월，장60례부합표준적식관암환자안조1：1적비례수궤분위저담저열량조（연구조）화전통담열량조（대조조），매조30례，균행개흉식관암절제흉내문합술。술후전5 d채용전장외영양지지치료，연구조안열량20 kCal/（kg·d），담0.1 g/（kg·d）급여，대조조안열량35 kCal/（kg·d），담0.2 g/（kg·d）급여。술후관찰병기록환자병발증적발생솔。술전1d、술후제3、6천측정혈장총단백、백단백、전백단백，술전화술후제1、3、6천사동맥혈기측PaO2、PaCO2、유산농도등지표，병재수주장외영양개시후3 h측말소혈당。결과：술후제3천화술후제6천량조각단백지표균교술전유소강저，단시차이무통계학의의（P>0.05）；연구조술후제1、3、6천적PaO2현저고대조조（P<0.05）；연구조술후PaCO2、유산화말소혈당요현저저우대조조（P<0.05）。연구조술후심률실상、폐부감염、도구감염화문합구루적발생솔비교차이무통계학의의（P>0.05）；연구조술후총적병발증발생솔현저저우대조조（P<0.05）。결론：식관암술후저담저열량장외영양여전통담열량상비영양상태상사，단능경호공제술후혈당수평，유리우강저폐손상급강저총적병발증발생솔。
Objective:To assess the impact of hypocalorie and lower nitrogen parenteral nutrition on blood glucose,postoperative complications and nutritional status of patients underwent esophageal resection. Method:Sixty patients underwent esophageal resection from January 2012 to December 2013 were divided into two groups by 1:1 ratio randomizely. All the patients received total parenteral nutrition(TPN)in postoperative 5 days.Study group(n=30) received calorie 20 kCal/(kg·d)and nitrogen 0.1 g/(kg·d)in 3 L bag. Control group(n=30)received calorie 35 kCal/(kg·d)and nitrogen 0.2 g/(kg·d)in 3 L bag. The postoperative complications,the concentration of total protein,albumin,prealbumin on the 1st day before surgery and the 3rd,6th day after surgery,the concentration of PaO2,PaCO2 and lactic acid of arterial blood on the preoperative day and the 1st,3rd ,6th day after surgery,the peripheral blood glucose at the 3 hours after parenteral nutrition were recorded identify the difference between two groups. Result:The concentrations of total protein ,albumin,prealbumin in two groups on the 3rd ,6th day after surgery were lower than preoperative concentrations without significant differences between two groups(P>0.05). The concentration of PaO2 in study group on the 1st,3rd ,6th day after surgery were higer than that in control group with significant difference(P<0.05). The concentration of PaCO2,lactic acid of arterial blood and the peripheral blood glucose at the 3 hours after parenteral nutrition in study group on the 1st,3rd ,6th day after surgery were lower than that in control group with significant differences(P<0.05). There were no significant differencs between two groups in the incidience of postoperative complications such as arrhythmia,pulmonary infection,incision infection and anastomotic leak,however, there was significant differencs between two groups in the incidience of postoperative total complications. Conclusion:The nutritional status after esophageal resection in hypocalorie and lower nitrogen parenteral nutrition group is similar with in traditional nutrition group.The hypocalorie and lower nitrogen parenteral nutrition can control postoperative blood glucose level and total postoperative complication better than traditional nutrition group.