中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
10期
881-884
,共4页
杨华%赵刚%吴国举%周新平%肖刚
楊華%趙剛%吳國舉%週新平%肖剛
양화%조강%오국거%주신평%초강
胃肿瘤%胃肠外营养
胃腫瘤%胃腸外營養
위종류%위장외영양
Gastric neoplasms%Parenteral nutrition
目的 探讨老年胃癌根治术患者围术期肠内营养(EN)序贯治疗的营养评估、临床效果,以及EN序贯治疗较肠外营养(PN)支持的安全性、可行性及优效性. 方法 选取北京医院胃肠外科50例65岁以上老年胃癌患者,随机分为EN和完全PN两组,各25例.对人组患者应用NRS2002评分系统进行营养评估,EN组术前2d开始给予瑞素,术后12h开始序贯给予维沃、百普力和瑞素;TPN组经中心静脉进行PN,共7d. 结果 EN组术后第3天、第7天平均淋巴细胞绝对值分别为(1.22±0.23)×109/L、(1.31±0.21)×109/L,前白蛋白水平分别为(151.42±48.15)mg/L、(167.38±46.23)mg/L,转铁蛋白(1.71±0.33)g/L、(1.83±0.31)g/L; PN组术后第3天、第7天平均淋巴细胞绝对值分别为(1.02±0.21)×109/L、(1.14±0.23)×109/L,前白蛋白水平分别为(115.22±47.34)mg/L、(131.27±43.58)mg/L,转铁蛋白水平分别为(1.50±0.32)g/L、(1.65±0.32)g/L,EN组术后第3天、第7天显著高于PN组(P＜0.05).PN组术后第3天、第7天急性期反应蛋白(CRP)值分别为(63.71±35.26) mg/L、(41.58±22.55) mg/L,明显高于EN组(54.26±29.13)mg/L、(18.12±14.35)mg/L(P＜0.05).EN组术后第3天、第7天血糖分别为(5.93±1.12)mmol/L、(5.61±1.03) mmol/L;胰岛素分别为(6.72±5.14) U/L、(6.21±2.63) U/L,均明显低于PN组术后第3天、第7天血糖(8.31±2.62) mmol/L、(8.85±2.92) mmol/L,胰岛素(12.81±7.26)U/L、(15.21±8.24) U/L(P＜0.05).术后第7天PN组谷丙转氨酶(ALT) (38.43±18.37)U/L显著高于EN组(23.91±14.82)U/L(P＜0.05).EN组围术期相关费用(2714.5±1391.7)元,低于PN组(5041.6±3007.7)元(P＜0.05);对于术后并发胃排空障碍患者,EN组营养费用降低更明显.两组患者在术后肝肾功能变化及并发症方面差异无统计学意义. 结论 围术期EN序贯治疗应用于老年胃癌患者安全、可行,老年胃癌患者早期EN治疗较PN支持能显著降低手术创伤引起的应激反应,减轻胰岛素抵抗和改善术后应激性高血糖、促进胃肠道功能恢复和降低医药费用,有利于老年胃癌患者术后的康复.
目的 探討老年胃癌根治術患者圍術期腸內營養(EN)序貫治療的營養評估、臨床效果,以及EN序貫治療較腸外營養(PN)支持的安全性、可行性及優效性. 方法 選取北京醫院胃腸外科50例65歲以上老年胃癌患者,隨機分為EN和完全PN兩組,各25例.對人組患者應用NRS2002評分繫統進行營養評估,EN組術前2d開始給予瑞素,術後12h開始序貫給予維沃、百普力和瑞素;TPN組經中心靜脈進行PN,共7d. 結果 EN組術後第3天、第7天平均淋巴細胞絕對值分彆為(1.22±0.23)×109/L、(1.31±0.21)×109/L,前白蛋白水平分彆為(151.42±48.15)mg/L、(167.38±46.23)mg/L,轉鐵蛋白(1.71±0.33)g/L、(1.83±0.31)g/L; PN組術後第3天、第7天平均淋巴細胞絕對值分彆為(1.02±0.21)×109/L、(1.14±0.23)×109/L,前白蛋白水平分彆為(115.22±47.34)mg/L、(131.27±43.58)mg/L,轉鐵蛋白水平分彆為(1.50±0.32)g/L、(1.65±0.32)g/L,EN組術後第3天、第7天顯著高于PN組(P＜0.05).PN組術後第3天、第7天急性期反應蛋白(CRP)值分彆為(63.71±35.26) mg/L、(41.58±22.55) mg/L,明顯高于EN組(54.26±29.13)mg/L、(18.12±14.35)mg/L(P＜0.05).EN組術後第3天、第7天血糖分彆為(5.93±1.12)mmol/L、(5.61±1.03) mmol/L;胰島素分彆為(6.72±5.14) U/L、(6.21±2.63) U/L,均明顯低于PN組術後第3天、第7天血糖(8.31±2.62) mmol/L、(8.85±2.92) mmol/L,胰島素(12.81±7.26)U/L、(15.21±8.24) U/L(P＜0.05).術後第7天PN組穀丙轉氨酶(ALT) (38.43±18.37)U/L顯著高于EN組(23.91±14.82)U/L(P＜0.05).EN組圍術期相關費用(2714.5±1391.7)元,低于PN組(5041.6±3007.7)元(P＜0.05);對于術後併髮胃排空障礙患者,EN組營養費用降低更明顯.兩組患者在術後肝腎功能變化及併髮癥方麵差異無統計學意義. 結論 圍術期EN序貫治療應用于老年胃癌患者安全、可行,老年胃癌患者早期EN治療較PN支持能顯著降低手術創傷引起的應激反應,減輕胰島素牴抗和改善術後應激性高血糖、促進胃腸道功能恢複和降低醫藥費用,有利于老年胃癌患者術後的康複.
목적 탐토노년위암근치술환자위술기장내영양(EN)서관치료적영양평고、림상효과,이급EN서관치료교장외영양(PN)지지적안전성、가행성급우효성. 방법 선취북경의원위장외과50례65세이상노년위암환자,수궤분위EN화완전PN량조,각25례.대인조환자응용NRS2002평분계통진행영양평고,EN조술전2d개시급여서소,술후12h개시서관급여유옥、백보력화서소;TPN조경중심정맥진행PN,공7d. 결과 EN조술후제3천、제7천평균림파세포절대치분별위(1.22±0.23)×109/L、(1.31±0.21)×109/L,전백단백수평분별위(151.42±48.15)mg/L、(167.38±46.23)mg/L,전철단백(1.71±0.33)g/L、(1.83±0.31)g/L; PN조술후제3천、제7천평균림파세포절대치분별위(1.02±0.21)×109/L、(1.14±0.23)×109/L,전백단백수평분별위(115.22±47.34)mg/L、(131.27±43.58)mg/L,전철단백수평분별위(1.50±0.32)g/L、(1.65±0.32)g/L,EN조술후제3천、제7천현저고우PN조(P＜0.05).PN조술후제3천、제7천급성기반응단백(CRP)치분별위(63.71±35.26) mg/L、(41.58±22.55) mg/L,명현고우EN조(54.26±29.13)mg/L、(18.12±14.35)mg/L(P＜0.05).EN조술후제3천、제7천혈당분별위(5.93±1.12)mmol/L、(5.61±1.03) mmol/L;이도소분별위(6.72±5.14) U/L、(6.21±2.63) U/L,균명현저우PN조술후제3천、제7천혈당(8.31±2.62) mmol/L、(8.85±2.92) mmol/L,이도소(12.81±7.26)U/L、(15.21±8.24) U/L(P＜0.05).술후제7천PN조곡병전안매(ALT) (38.43±18.37)U/L현저고우EN조(23.91±14.82)U/L(P＜0.05).EN조위술기상관비용(2714.5±1391.7)원,저우PN조(5041.6±3007.7)원(P＜0.05);대우술후병발위배공장애환자,EN조영양비용강저경명현.량조환자재술후간신공능변화급병발증방면차이무통계학의의. 결론 위술기EN서관치료응용우노년위암환자안전、가행,노년위암환자조기EN치료교PN지지능현저강저수술창상인기적응격반응,감경이도소저항화개선술후응격성고혈당、촉진위장도공능회복화강저의약비용,유리우노년위암환자술후적강복.
Objective To study the nutritional evaluation and clinical effects of perioperative enteral nutrition (EN) versus parenteral nutrition support (PN) in elderly patients undergoing gastrectomy for gastric carcinoma.The safety,feasibility and superiority were also compared between EN and PN.Methods Totally 50 cases (aged 65 years and over) undergoing gastrectomy for gastric carcinoma in Department of Gastrointestinal Surgery of Beijing Hospital were recruited and divided randomly into two groups of EN and PN (25 cases for each).NRS2002 nutritional assessment scoring system was used to evaluate the patients.The patients in EN group were given Rui Su at 2 d before surgery,then Wei wo,Bai pu li and Rui su were sequentially given from 12 h after the surgery.The patients in PN group were received total parenteral nutrition (TPN) via central venous for 7 days.Results The average absolute lymphocytes[(1.22±0.23) ×109/L and (1.31±0.27) ×109/L vs.(1.02±0.21) × 109/ L and (1.14 ± 0.23 × 10)9/L],pre-albumin[(151.442± 48.15) mg/ L and (167.38± 46.23) mg/ L vs.(115.22 ± 47.34) mg/L and (131.27 ± 43.58) mg/L] and transferring [(1.71±0.33)g /L and (1.83±0.31)g/L vs.(1.50±0.32)g/L and (1.65±0.32)g/L,all P＜0.05] levels after surgery of 3 d and 7 d in EN group were higher than those of PN group (P＜0.05).The CRP levels at 3 d and 7 d after surgery were increased in PN group compared with EN group [(63.71±35.26)mg/L and (41.58 ± 22.55)mg/L vs.(54.26±29.13)mg/L and (18.12 ±14.35)mg/L,P＜0.05].The blood sugar and insulin levels of EN group at 3 d and 7 d after surgery were (5.93±1.12) mmol/L and (5.61± 1.03)mmol/L,(6.72±5.14) U/L and (6.21±2.63) U/L,which were decreased compared to PN group (8.31 ± 2.62) mmol/L and (8.85 ± 2.92) mmol/L,(12.81±7.26) U/L and (15.21±8.24) U/L (P＜0.05).ALT in the PN group was (38.43±18.37) U/L at 7 d after surgery,higher than EN group (23.91± 14.82) U/L(P＜0.05).The perioperative average costs of EN group was (2714.5± 1391.7) yuan,lower than PN group (5041.6± 3007.7) yuan (P＜0.05).For the patients complicated with delayed gastric emptying after surgery,nutrition cost reduction was more evident.There were no significant difference between the two groups of patients in the liver and kidney function changes and postoperative complications.Conclusions It is safe and feasible for elderly gastric cancer patients with perioperative EN sequential therapy in view of its reduced stress response of surgical trauma and insulin resistance,improvement of hyperglycemia,reduction of medical costs compared with PN for elderly gastric cancer patients.
