肠内营养在实施加速康复外科的老年胃癌患者中的应用效果观察
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摘要
目的探讨在加速康复外科(ERAS)理念下,老年胃癌患者围术期施以肠内营养支持的临床效果。方法选择2016年9月至2018年8月在本院行胃癌根治术的136例老年患者为研究对象,所有患者围术期均给予ERAS策略,按随机数字表法分为肠内营养组和对照组,各68例,肠内营养组术后经空肠营养管输注肠内营养,对照组术后经口进食。比较两组患者的术后康复过程、营养状况、免疫功能水平及相关并发症的发生情况。结果肠内营养组患者首次排气时间、排便时间和术后住院天数均短于对照组,住院总费用少于对照组,差异均有统计学意义(P<0.05);术后第3天,肠内营养组患者营养状况(ALB,PA)明显好于对照组(P<0.05),免疫功能水平(IgG、IgA)也显著高于对照组(P<0.05);肠内营养组术后共发生并发症12例(17.65%),明显低于对照组的23例(33.82%),两组并发症发生率比较差异有统计学意义(P<0.05)。结论在ERAS理念下对老年胃癌患者术后给予肠内营养支持的效果优于经口进食,能够促进患者术后恢复,减少并发症的发生,具有较好的卫生经济学价值。
Objective To investigate the clinical effect of enteral nutrition in elderly patients with gastric cancer during perioperative period under the concept of accelerated rehabilitation surgery(ERAS). Methods A total of 136 elderly patients undergoing radical gastrectomy from September 2016 to August 2018 were selected as subjects. All patients were given ERAS strategy during perioperative period. According to random digital table, they were divided into enteral nutrition group(n=68) and control group(n=68). Enteral nutrition group was injected with jejunal nutrition tube after operation, and control group was fed orally after operation. Comparison of postoperative rehabilitation, nutritional status, immune function and related complications between the two groups. Results The first exhaust time, defecation time and postoperative hospitalization days in enteral nutrition group were shorter than those in control group, and the total hospitalization cost was less than that in control group(P<0.05). On the 3 rd day after operation, the nutritional status(ALB, PA) of the enteral nutrition group was significantly better than that of the control group(P<0.05), and the level of immune function(IgG, IgA) was significantly higher than that of the control group(P<0.05). There were 12 cases(17.65%) of postoperative complications in the enteral nutrition group, which was significantly lower than that in the control group(33.82%). There was statistically significant difference in the incidence of complications between the two groups(P<0.05). Conclusion The effect of enteral nutrition support on elderly patients with gastric cancer under the concept of ERAS is better than that of oral feeding. It can promote the recovery of patients after operation and reduce the incidence of complications. It has a good value of health economics.
Objective To investigate the clinical effect of enteral nutrition in elderly patients with gastric cancer during perioperative period under the concept of accelerated rehabilitation surgery(ERAS). Methods A total of 136 elderly patients undergoing radical gastrectomy from September 2016 to August 2018 were selected as subjects. All patients were given ERAS strategy during perioperative period. According to random digital table, they were divided into enteral nutrition group(n=68) and control group(n=68). Enteral nutrition group was injected with jejunal nutrition tube after operation, and control group was fed orally after operation. Comparison of postoperative rehabilitation, nutritional status, immune function and related complications between the two groups. Results The first exhaust time, defecation time and postoperative hospitalization days in enteral nutrition group were shorter than those in control group, and the total hospitalization cost was less than that in control group(P<0.05). On the 3 rd day after operation, the nutritional status(ALB, PA) of the enteral nutrition group was significantly better than that of the control group(P<0.05), and the level of immune function(IgG, IgA) was significantly higher than that of the control group(P<0.05). There were 12 cases(17.65%) of postoperative complications in the enteral nutrition group, which was significantly lower than that in the control group(33.82%). There was statistically significant difference in the incidence of complications between the two groups(P<0.05). Conclusion The effect of enteral nutrition support on elderly patients with gastric cancer under the concept of ERAS is better than that of oral feeding. It can promote the recovery of patients after operation and reduce the incidence of complications. It has a good value of health economics.
引文
[1]周志刚,李平.加速康复外科理念下肠内营养支持在胃癌患者围手术期的应用[J].实用医院临床杂志,2017,14(5):177-179.
[2] Maciej Ciesielski, Wiesaw J Kruszewski, Jakub Walc-zak, et al. Analysis of postoperative morbidity andmortality following surgery for gastric cancer. Sur-geon volume as the most significant prognostic fac-tor[J]. Prz Gastroenterol, 2017,12(3):215-221.
[3]梁晓路,孙世波,王恺,等.加速康复理念对肝切除术后应激反应的影响[J].当代医学,2018,24(11):1-5.
[4]王林,李平.加速康复外科理念下口服营养支持在胃癌病人围手术期的应用[J].肠外与肠内营养,2016,23(5):300-302.
[5]凌发昱,熊剑文,喻东亮,等.加速康复外科理念在微创食管癌根治术围手术期的应用价值[J].世界华人消化杂志,2017,25(16):1491-1496.
[6]中华医学会肠外肠内营养学分会.结直肠手术应用加速康复外科中国专家共识(2015版)[J].中华结直肠疾病电子杂志,2015,4(5):2-5.
[7] Bo-Yeoul Kim, Kyu-Joo Park, Seung-Bum Ryoo. Effectsof a Mobile Educational Program for Colorectal Can-cer Patients Undergoing the Enhanced Recovery AfterSurgery[J]. Open Nurs J, 2018,12(1):142-154.
[8]刘红霞,程康文,王贵和.加速康复外科护理在腹腔镜胃癌根治术中的应用效果[J].安徽医学,2018,39(5):613-616.
[9]陈亚梅.加速康复外科护理用于胃癌根治术后患者的康复效果及对早期离床活动的影响[J].当代医学,2017,23(36):64-67.
[10]陈声飞,阙剑锋,黄嘉俊,等.加速康复外科合并肠内营养技术在老年腔镜胃癌手术的应用及短期疗效评价[J].消化肿瘤杂志,2018,10(1):29-33.
[2] Maciej Ciesielski, Wiesaw J Kruszewski, Jakub Walc-zak, et al. Analysis of postoperative morbidity andmortality following surgery for gastric cancer. Sur-geon volume as the most significant prognostic fac-tor[J]. Prz Gastroenterol, 2017,12(3):215-221.
[3]梁晓路,孙世波,王恺,等.加速康复理念对肝切除术后应激反应的影响[J].当代医学,2018,24(11):1-5.
[4]王林,李平.加速康复外科理念下口服营养支持在胃癌病人围手术期的应用[J].肠外与肠内营养,2016,23(5):300-302.
[5]凌发昱,熊剑文,喻东亮,等.加速康复外科理念在微创食管癌根治术围手术期的应用价值[J].世界华人消化杂志,2017,25(16):1491-1496.
[6]中华医学会肠外肠内营养学分会.结直肠手术应用加速康复外科中国专家共识(2015版)[J].中华结直肠疾病电子杂志,2015,4(5):2-5.
[7] Bo-Yeoul Kim, Kyu-Joo Park, Seung-Bum Ryoo. Effectsof a Mobile Educational Program for Colorectal Can-cer Patients Undergoing the Enhanced Recovery AfterSurgery[J]. Open Nurs J, 2018,12(1):142-154.
[8]刘红霞,程康文,王贵和.加速康复外科护理在腹腔镜胃癌根治术中的应用效果[J].安徽医学,2018,39(5):613-616.
[9]陈亚梅.加速康复外科护理用于胃癌根治术后患者的康复效果及对早期离床活动的影响[J].当代医学,2017,23(36):64-67.
[10]陈声飞,阙剑锋,黄嘉俊,等.加速康复外科合并肠内营养技术在老年腔镜胃癌手术的应用及短期疗效评价[J].消化肿瘤杂志,2018,10(1):29-33.