CAJ | 학술논문

目的：探讨早期肠内营养对晚期胰腺癌患者营养状况和并发症的影响。方法选择2012年1月—2013年12月海军总医院肿瘤科和消化内科收治的晚期胰腺癌患者68例，将其按照入院后24~72 h 是否接受鼻空肠管置管行肠内营养支持分为肠内营养组（33例）和对照组（35例）。肠内营养组患者给予肠内营养粉支持，对照组患者给予普通流质饮食。两组患者在给予营养支持的同时，均给予同类肠道益生菌及镇痛等对症治疗。于治疗第1天和第30天时观察两组营养指标，包括体质指数（BMI）、肱三头肌皮褶厚度、上臂围；生化指标，包括空腹血糖、血清总蛋白、清蛋白、胆固醇、三酰甘油；肝功能指标，包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素（TBiL）；以及两组肠道并发症和感染发生率。结果治疗前，两组 BMI、肱三头肌皮褶厚度、上臂围比较，差异均无统计学意义（P ＞0.05）；治疗后，肠内营养组 BMI、肱三头肌皮褶厚度、上臂围均高于对照组（P ＜0.05）。治疗前，两组血糖、总蛋白、清蛋白、胆固醇、三酰甘油比较，差异均无统计学意义（P ＞0.05）；治疗后，肠内营养组空腹血糖、总蛋白、清蛋白、胆固醇均高于对照组（P ＜0.05）。治疗前，两组 ALT、AST、TBiL 比较，差异均无统计学意义（P ＞0.05）；治疗后，肠内营养组 ALT、AST、TBiL 均低于对照组（P ＜0.05）。两组腹胀发生率比较，差异无统计学意义（P ＞0.05）；肠内营养组腹泻、便秘、感染发生率均低于对照组（P ＜0.05）。结论早期肠内营养支持治疗可有效改善晚期胰腺癌患者的营养状况，降低肝功能受损、腹泻、便秘和感染的发生率。
목적：탐토조기장내영양대만기이선암환자영양상황화병발증적영향。방법선택2012년1월—2013년12월해군총의원종류과화소화내과수치적만기이선암환자68례，장기안조입원후24~72 h 시부접수비공장관치관행장내영양지지분위장내영양조（33례）화대조조（35례）。장내영양조환자급여장내영양분지지，대조조환자급여보통류질음식。량조환자재급여영양지지적동시，균급여동류장도익생균급진통등대증치료。우치료제1천화제30천시관찰량조영양지표，포괄체질지수（BMI）、굉삼두기피습후도、상비위；생화지표，포괄공복혈당、혈청총단백、청단백、담고순、삼선감유；간공능지표，포괄병안산안기전이매（ALT）、천동안산안기전이매（AST）화총담홍소（TBiL）；이급량조장도병발증화감염발생솔。결과치료전，량조 BMI、굉삼두기피습후도、상비위비교，차이균무통계학의의（P ＞0.05）；치료후，장내영양조 BMI、굉삼두기피습후도、상비위균고우대조조（P ＜0.05）。치료전，량조혈당、총단백、청단백、담고순、삼선감유비교，차이균무통계학의의（P ＞0.05）；치료후，장내영양조공복혈당、총단백、청단백、담고순균고우대조조（P ＜0.05）。치료전，량조 ALT、AST、TBiL 비교，차이균무통계학의의（P ＞0.05）；치료후，장내영양조 ALT、AST、TBiL 균저우대조조（P ＜0.05）。량조복창발생솔비교，차이무통계학의의（P ＞0.05）；장내영양조복사、편비、감염발생솔균저우대조조（P ＜0.05）。결론조기장내영양지지치료가유효개선만기이선암환자적영양상황，강저간공능수손、복사、편비화감염적발생솔。
Objective To investigate the impact of early enteral nutrition( EN) on the nutritional status and complications of patients with advanced pancreatic carcinomas(APC). Methods 68 APC patients admitted to Navy General Hospital from january 2012 to December 2013 were divided,according to whether receiving nasal jejunal feeding tubes at hours 24 to 72 after hospitalization,into groups EN(n = 33),control(n = 35). Group EN were given EN powder support,control group given ordinary liquid diet. Both groups had similar probiotics,analgesic and other symptomatic treatment. Body mass index(BMI),brachial triceps skinfold thickness(BTST),upper arm circumference(UAC),fasting blood glucose(FBG), serum total protein( STP),albumin( AL),cholesterol,triglyceride( TG),alanine aminotransferase( ALT),aspartate aminotransferase(AST),total bilirubin(TBiL)and the incidences of intestinal complications and infection were observed on days 1,30 of treatment. Results Before treatment,there was no significant difference between 2 group in BMI,BTST,UAC (P > 0. 05). After treatment,BMI,BTST,UAC were higher in EN group than in control group(P < 0. 05). There was no difference in FBG,STP,AL,cholesterol,TG between 2 groups before treatment(P > 0. 05),and higher in EN group than in control group after treatment(P < 0. 05). There was no difference in ALT,AST,TBiL between 2 groups before treatment(P> 0. 05),and lower in EN group than in control group after treatment( P < 0. 05). No difference was noted in abdominal distension incidence between 2 groups(P > 0. 05). The incidences of diarrhea,constipation,infection were lower in EN group than in control group(P < 0. 05). Conclusion Early EN support can effectively improve the nutritional status,reduce liver function damages and incidences of diarrhea,constipation,infection in APC patients.