摘要
目的比较肠外营养（PN）、肠内营养（EN）和肠内外相结合的互补营养（CN），对胃癌切除手术后病人恢复的不同影响。方法将连续收治适合切除手术的90例胃癌病人随机分成三组，进行前瞻性研究。1）PN（n=30）组。2）EN（n=30）组：经空肠道倭管在24小时内以大约80ml／hr速度匀速注入全量日需营养。3）CN（n=30）组：术后第1天经静脉给予3／4量的日需营养，经空肠造瘘管以20ml／hr匀速注入1／4量的日需营养。此后依病人肠功能恢复情况逐渐减少PN而逐渐增加EN，至术后第5天经空肠造瘘管注入全量日需营养。各种方式营养均在术后第1天开始给予至第5天营养输完而结束。三组病人均技术前公斤体重给以等值热卡和氮量。测定病人手术前及术后第6天时的体重、血白细胞计数以及血清白蛋白水平，同时记录术后肠功能恢复时间及并发症发生情况。结果1）CN组和EN组肠功能恢复距手术结束时间（小时）显著短于PN组（PN组7Z．5±0．3，EN组34．8±0．6，CN组36．7±0．5，P＜0．05）。2）CN组术后9天内主要并发症发生率（20．0％）显著低于PN组（56．7％）和EN组（100％，P＜0．05）。对手术前第5天，三组间血白细胞计数正常者所占比率（PN96．7％，EN100％，CN96．7％）、血清白蛋白水平（PN4．1±0．5g／dl，EN4．0±O．
Purpose To evaluate the effects of parenteral nutrition (PN), enteral nutrition (EN) and complementary nutrition (CN) on the recovery of patients received gastrectomy for cancer. Methods Ninety consecutive patients received surgery for carcinoma of stomach were randomized into 3 groups. 1) PN(n = 30). 2) EN(n = 30):The nutrition was given continuously in 24 hours at about 80 ml/hr via catheter jejunostomy. 3) CN (n = 30): On POD1, 75 percent of the whole daily nutrition were given by PN, the rest 25 percent by EN. From POD2 EN was progressed to the optimal goal of 80ml/hr by POD5 and PN was reduced gradually to nothing. All the feedings were started isocaloricly and isonitrogenously on POD1 and were maintained by POD5. The pre and optoperative body weight,the time needed for bowel movement to recover and the postoperative complications were recored. The serum albumin and the blood WBC count were determined pre and postoperatively. Results 1) The time needed for bowel movement to recover (Hrs) was sighficantly shorter in groups CN (36. 7±0.5) and EN (34. 8 ± 0. 6) than that in gnp PN (72. 5 ±0. 3), P<0.05. 2) The rate of main postoperative complications was significantIy lower in CN (26. 7%) than those in EN (100%) and PN (56.7%), P < 0.05.3) On AOD5, there was no significant difference in the percentage Of patients with normal count of blood WBC (PN 96. 7%, EN 100%,CN 96. 7%, P>0. 05), the level of serum albumin (g/dl) (PN 4. 1 ± 0. 5,EN 4. 0±0. 3,CN 3. 9 ± 0. 1,P>0. 05) and the body weight (kg) (PN 62. 6 ± 0. 4, EN 63.1 ± 0. 3, CN 62. 9 ± 0. 4, P >0. 05) among the 3 groups. But on POD6, the level of serum albumin(g/dl) (PN 4.0±0. 3,EN 3. 1 ± 0. 2,CN 4. 1± 0. 4) and the body weight (kg) (PN 62. 7 ± 0. 5,EN 58. 0 ±0. 3,CN 63. 0±0. 2) were significantly higher in groups CN and PN than those in group EN (P< 0. 05);The Percentage of patients with normal count of blood WBC was significantly higher in CN (93. 3%) and EN (90%) than that in PN (66. 7%), P<0. 05. Conlusions Complementary nutrition of the combination of PN and EN could enhance the recovery of bowel movement and the returning of the blood WBC count to normal postoperatively. It could keep the serum albumin level and the body weight perioperatively. The optoperative complications were significantly reduced in CN group. CN is the best feeding fashion for patients received gastrectomy for cancer.
出处
《中国临床营养杂志》
1999年第4期176-176,共1页
Chinese Journal of Clinical Nutrition
