不同营养途径对食管癌合并2型糖尿病患者术后状态的影响
불동영양도경대식관암합병2형당뇨병환자술후상태적영향
Effect of Different Nutritional Approaches on the Postoperative Status of Patients With Esophageal Cancer Combined With Type 2 Diabetes
  • 万方数据
    中国全科医学 중국전과의학
    Chinese General Practice
    2015年 33期 4044-4048,4049 ,共6页

    李俊杰%刘志良%赵亚男%邵珠福%张波

    리준걸%류지량%조아남%소주복%장파

    食管肿瘤%糖尿病,2 型%肠道营养 食管腫瘤%糖尿病,2 型%腸道營養
    식관종류%당뇨병,2 형%장도영양
    Esophageal neoplasms%Diabetes mellitus,type 2%Enteral nutrition
    目的：观察不同营养途径对食管癌合并2型糖尿病患者术后状态的影响。方法选择2012年11月—2014年11月于辽宁医学院附属第一医院行手术治疗的食管癌合并2型糖尿病患者40例，按入院次序编号，编号为奇数的归入试验组（20例），编号为偶数的归入对照组（20例）。试验组采用经鼻十二指肠营养管或空肠造瘘营养管行肠内营养和中心静脉滴注营养液，对照组采用中心静脉滴注营养液。两组患者分别于术后第1、2、3、4、5、6、7天检测血糖水平（4次/ d），于术前1 d，术后1、3、7 d 晨起未给予营养液前检测营养指标〔血浆前清蛋白（PA）、血浆清蛋白（ALB）、血红蛋白（Hb）、转铁蛋白（TRF）、肱三头肌皮褶厚度（TSF）、淋巴细胞计数（LY）〕。观察两组患者术后胃肠道功能恢复情况（肠鸣音恢复时间、第1次排气时间、第1次排便时间）、平均住院时间、卡式功能状态（Karnofsky）评分及心脏并发症（心律失常、心功能不全、心力衰竭）、感染相关并发症（肺部感染、泌尿系统感染等）发生率。结果术后7 d 内两组患者血糖水平波动于6.00～9.00 mmol/ L。不同营养途径与不同时间点对血糖水平影响无交互作用（F交互＝1.888，P ＞0.05）；不同时间点对血糖水平影响有统计学意义（F时间＝8.427，P ＜0.05）；不同营养途径对血糖水平影响有统计学意义（F组间＝36.689，P ＜0.05）。不同营养途径与不同时间点对 ALB 影响存在交互作用（P ＜0.05）；不同营养途径与不同时间点对 PA、Hb、TRF、TSF、LY 影响无交互作用（P ＞0.05）。不同时间点对 PA、ALB、Hb、TRF、LY 影响有统计学意义（P ＜0.05）；不同营养途径对 PA、ALB、Hb、TRF、TSF、LY 影响有统计学意义（P ＜0.05）。试验组患者术后肠鸣音恢复时间、第1次排气时间、第1次排便时间及平均住院时间均短于对照组（P ＜0.05）；试验组 Karnofsky 评分高于对照组（P ＜0.05）。患者术后未出现死亡及吻合口瘘等严重并发症，试验组患者心脏并发症发生率为10.0％（2/20）、感染相关并发症发生率为15.0％（3/20），低于对照组的30.0％（6/20）和45.0％（9/20）（P ＜0.05）。结论食管癌合并2型糖尿病患者术后早期联合应用静脉营养和肠内营养，更有利于术后血糖水平的控制，可提高患者机体状态，促进肠道功能恢复，降低术后并发症的发生率。
    목적：관찰불동영양도경대식관암합병2형당뇨병환자술후상태적영향。방법선택2012년11월—2014년11월우료녕의학원부속제일의원행수술치료적식관암합병2형당뇨병환자40례，안입원차서편호，편호위기수적귀입시험조（20례），편호위우수적귀입대조조（20례）。시험조채용경비십이지장영양관혹공장조루영양관행장내영양화중심정맥적주영양액，대조조채용중심정맥적주영양액。량조환자분별우술후제1、2、3、4、5、6、7천검측혈당수평（4차/ d），우술전1 d，술후1、3、7 d 신기미급여영양액전검측영양지표〔혈장전청단백（PA）、혈장청단백（ALB）、혈홍단백（Hb）、전철단백（TRF）、굉삼두기피습후도（TSF）、림파세포계수（LY）〕。관찰량조환자술후위장도공능회복정황（장명음회복시간、제1차배기시간、제1차배편시간）、평균주원시간、잡식공능상태（Karnofsky）평분급심장병발증（심률실상、심공능불전、심력쇠갈）、감염상관병발증（폐부감염、비뇨계통감염등）발생솔。결과술후7 d 내량조환자혈당수평파동우6.00～9.00 mmol/ L。불동영양도경여불동시간점대혈당수평영향무교호작용（F교호＝1.888，P ＞0.05）；불동시간점대혈당수평영향유통계학의의（F시간＝8.427，P ＜0.05）；불동영양도경대혈당수평영향유통계학의의（F조간＝36.689，P ＜0.05）。불동영양도경여불동시간점대 ALB 영향존재교호작용（P ＜0.05）；불동영양도경여불동시간점대 PA、Hb、TRF、TSF、LY 영향무교호작용（P ＞0.05）。불동시간점대 PA、ALB、Hb、TRF、LY 영향유통계학의의（P ＜0.05）；불동영양도경대 PA、ALB、Hb、TRF、TSF、LY 영향유통계학의의（P ＜0.05）。시험조환자술후장명음회복시간、제1차배기시간、제1차배편시간급평균주원시간균단우대조조（P ＜0.05）；시험조 Karnofsky 평분고우대조조（P ＜0.05）。환자술후미출현사망급문합구루등엄중병발증，시험조환자심장병발증발생솔위10.0％（2/20）、감염상관병발증발생솔위15.0％（3/20），저우대조조적30.0％（6/20）화45.0％（9/20）（P ＜0.05）。결론식관암합병2형당뇨병환자술후조기연합응용정맥영양화장내영양，경유리우술후혈당수평적공제，가제고환자궤체상태，촉진장도공능회복，강저술후병발증적발생솔。
    Objective To explore the effect of different nutritional approaches on the postoperative status of patients with esophageal cancer combined with type 2 diabetes. Methods The study enrolled 40 patients with esophageal cancer combined with type 2 diabetes who received operative treatment in the First Affiliated Hospital of Liaoning Medical University from November 2012 to November 2014. According to the sequence number of admission,patients with odd number were assigned into trial group (n = 20),and patients with even number were assigned into control group(n = 20). The trial group was administrated with enteral nutrition by nasal duodenal nutrition tube or jejunostomy feeding tube,and the control group was administrated with nutrient solution by central intravenous drip. On 1,2,3,4,5,6,and 7 days after surgery,peripheral blood sugar level was detected by 4 times per day. One day before surgery,and on day 1,day 3 and day 7 after surgery,nutritive indexes( PA,&nbsp;ALB,Hb,TRF,TSF and LY) were detected in the morning before nutrition solution was administrated. We observed the recovery of gastrointestinal function after surgery(the time needed for the recovery of bowel sounds,the first exhaust time and the first defecation time),average hospital stay,Karnofsky score and the incidence rates of cardiac complications( arrhythmia, cardiac insufficiency and heart failure)and infection related complications(pulmonary infection and infection of urinary system) of the two groups. Results On 7 days after surgery,the peripheral blood sugar level fluctuated between 6. 00 and 9. 00 mmol/ L. There was no interaction between different nutritional approaches and different time points in the influence on peripheral blood sugar level(Finteraction = 1. 888,P > 0. 05);different time points had significant influence on peripheral blood sugar level(Ftime= 8. 427,P < 0. 05);different nutritional approaches had significant influence on peripheral blood sugar level( Finter - group= 36. 689,P < 0. 05). There was interaction between different nutritional approaches and different time points in the influence on ALB(P < 0. 05);there was no interaction(P > 0. 05)between different nutritional approaches and different time points in the influence on PA,Hb,TRF,TSF and LY. Different time points had significant influence(P < 0. 05)on PA,ALB,Hb, TRF and LY;different nutritional approaches had significant influence(P < 0. 05)on PA,ALB,Hb,TRF,TSF and LY. Trial group was shorter(P < 0. 05)than control group in the time needed for the recovery of bowel sounds,the first exhaust time,the first defecation time and average hospital stay;trial group was higher than control group in Karnofsky score( P < 0. 05). No death and severe complications like anastomotic fistula occurred in the patients after surgery. The incidence of cardiac complications was 10. 0% (2 / 20)and the incidence of infection - related complications was 15. 0% (3 / 20),lower than those of control group( P < 0. 05 ),which were 30. 0% ( 6 / 20 ) and 45. 0% ( 9 / 20 ) respectively. Conclusion The early administration of intravenous nutrition combined with enteral nutrition on patients with esophagus cancer combined with type 2 diabetes helps control postoperative blood glucose level,improve the body state of patients,accelerate intestinal function recovery and reduce the occurrence of complications after surgery.
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