CAJ | 학술논문

目的观察术后低氮低热量营养支持对腹腔镜大肠癌术后患者短期疗效的影响.方法将84例结直肠癌患者随机分为研究组和对照组,研究组(n=42)采用标准化肠外营养液[ 脂肪乳氨基酸(17)葡萄糖(11％)注射液](卡文),平均摄入热量( 73.35±8.37) kJ/(kg·d),氮量(0.10±0.01) mol/(kg·d).对照组(n=42)按患者所测定的静息量消耗值,平均摄入热量(125.58±8.37)k J/( kg ·d),氮量(0.24±0.06)mol/( kg·d),采用“全合一”无菌配置标准提供,术后进行5d的肠外营养支持.观察两组血生化、并发症、术后住院时间.结果研究组血糖值升高的幅度及波动范围明显小于对照组,差异有统计学意义(P＜0.01).两组血浆总蛋白、白蛋白、前白蛋白水平比较差异无统计学意义(P＞0.05).肺部感染、泌尿道感染、切口感染并发症发生率两组差异无统计学意义(P＞0.05).总、感染性并发症发生率(研究组7.1％比对照组23.8％,P＜O.05),静脉炎发生率(2.4％比21.4％,P＜0.01),全身炎症生反应综合征发生率(SIRS,21.4％比47.6％,P＜0.05),差异有统计学意义.术后住院时间:研究组为(10.5±3.7)d,对照组为(11.2±4.0)d,差异无统计学意义(P＞0.05).结论腹腔镜大肠癌根治术后低氮、低热量肠外营养比较传统肠外营养能更好的控制术后血糖水平,降低了总感染性并发症发生率及静脉炎、SIRS发生率.
목적 관찰술후저담저열량영양지지대복강경대장암술후환자단기료효적영향.방법 장84례결직장암환자수궤분위연구조화대조조,연구조(n=42)채용표준화장외영양액[ 지방유안기산(17)포도당(11％)주사액](잡문),평균섭입열량( 73.35±8.37) kJ/(kg·d),담량(0.10±0.01) mol/(kg·d).대조조(n=42)안환자소측정적정식량소모치,평균섭입열량(125.58±8.37)k J/( kg ·d),담량(0.24±0.06)mol/( kg·d),채용“전합일”무균배치표준제공,술후진행5d적장외영양지지.관찰량조혈생화、병발증、술후주원시간.결과 연구조혈당치승고적폭도급파동범위명현소우대조조,차이유통계학의의(P＜0.01).량조혈장총단백、백단백、전백단백수평비교차이무통계학의의(P＞0.05).폐부감염、비뇨도감염、절구감염병발증발생솔량조차이무통계학의의(P＞0.05).총、감염성병발증발생솔(연구조7.1％비대조조23.8％,P＜O.05),정맥염발생솔(2.4％비21.4％,P＜0.01),전신염증 생반응종합정발생솔(SIRS,21.4％비47.6％,P＜0.05),차이유통계학의의.술후주원시간:연구조위(10.5±3.7)d,대조조위(11.2±4.0)d,차이무통계학의의(P＞0.05).결론 복강경대장암근치술후저담、저열량장외영양비교전통장외영양능경호적공제술후혈당수평,강저료총감염성병발증발생솔급정맥염、SIRS발생솔.
Objective To evaluate the short-term impact of hypocaloric and hyponitrogenic parenteral nutrition ( PN ) in patients after laparoscopic radical resection for colorectal cancer.Methods Eightyfour patients with colorectal carcinoma were randomly divided into two groups. Study group ( n =42 ) received calorie (73.35 ±8.37) kJ/(kg·day) and nitrogen (0.10 ±0.01 ) mol/(kg·d) using a standardized regimen ( KabivenTM PI, Fresenius Kabi, Germany ). Control group ( n =42 ) received calorie ( 125.58 ±8.37 ) kJ/(kg·day) and nitrogen (0.24 ±0.06) mol/(kg·day) in regular "3 liter bag". PN was infused continuously for 5 days postoperatively. Biochemical indicators, infectious complications and postoperative hospital stay were recorded to identify the difference between the two groups.Results The fluctuations of blood glucose levels in study group were lower than those in control group with significant difference ( P ＜ 0.05 ). Comparison of serum concentrations of total protein, albumin and prealbumin between two groups had no significant difference ( P ＞ 0.05 ). Comparison of the complication rate of pulmonary infection,urinary tract infection and wound infection between two groups had no significant difference (P ＞0.05). The total infectious complication rate in study group was 7.1 ％,significantly lower than that in control group (23.8％,P ＜ 0.05 ). The phlebitis rate in study group was 2.4％,significantly lower than that in control group (21.4％,P ＜0.01 ),and the systemic inflammatory response syndrome (SIRS) rate in study group was 21.4％,significantly lower than that in control group (47.6％,P ＜ 0.05 ). But there was no significant difference in the postoperative hospital stay between the two groups ( P ＞ 0.05 ).Conclusion Hypocaloric and hyponitrogenic PN after laparoscopic radical resection of colorectal cancer can control postoperative blood glucose levels better than traditional PN does, and decrease the rate of infectious complications,phlebitis and SIRS.