[1]汤亲青,乐建军,曹先东.胃癌术后应用肠内营养制剂的对比研究[J].肠外与肠内营养杂志,2021,(03):147-151.[doi:10.16151/j.1007-810x.2021.03.005]
　TANG Qin-qing,LE Jian-jun,CAO Xian-dong.Comparative study of enteral nutrition in gastric cancer after operation[J].PARENTERAL & ENTERAL NUTRITION,2021,(03):147-151.[doi:10.16151/j.1007-810x.2021.03.005]
点击复制

胃癌术后应用肠内营养制剂的对比研究
分享到：

《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2021年03期
页码:
147-151
栏目:
论著
出版日期:
2021-05-10

文章信息/Info

Title:
Comparative study of enteral nutrition in gastric cancer after operation
作者:
汤亲青 1; 乐建军 2; 曹先东 1
安徽医科大学第一附属医院，1.普通外科；2.全科医学科，安徽合肥 230022
Author(s):
TANG Qin-qing1;  LE Jian-jun2;  CAO Xian-dong1
1.Department of General Surgery；2.Department of General Practice, the First Affiliated Hospital of Anhui Medical, Hefei 230022, Anhui, China
关键词:
胃癌 ; 肠内营养 ; 营养状况
Keywords:
Gastric cancer;  Enteral nutrition;  Nutritional status
分类号:
R459.3
DOI:
10.16151/j.1007-810x.2021.03.005
文献标志码:
A
摘要:
目的：本研究拟比较不同类型肠内营养（EN）制剂对胃癌术后病人营养状态和耐受性的影响。 方法：收集2017年11月到2021年2月安徽医科大学第一附属医院普通外科（高新院区胃肠外科二病区）胃癌术后予以EN病人的术前、术后实施EN前（EN前）、实施EN后（EN后）的血液指标（包括总蛋白、白蛋白、前白蛋白、血红蛋白）及禁食水时间、腹腔引流管拔管时间、EN使用时间、EN起始时间、术后住院时间和EN费用。比较三组营养指标和耐受性的差异性。 结果：共纳入符合标准病人125例，短肽组百普力（SP）28例、整蛋白能全力组（TPF）26例和整蛋白瑞素组（TP）71例。125例病人术前、实施EN前、实施EN后病人总蛋白、白蛋白、前白蛋白、血红蛋白结果有统计学差异(P < 0.05)；三组病人EN费用具有统计学差异(P < 0.05)；三组病人术前、EN前、EN后总蛋白、白蛋白、前白蛋白、血红蛋白结果及禁食时间、腹腔引流管拔管时间、EN使用时间、EN距术后间隔时间、术后住院时间无统计学差异(P > 0.05)。耐受性比较显示SP耐受性较好。EN费用由高到低分别是SP、TPF和TP。 结论：SP、TPF、TP EN制剂可改善胃癌术后病人的营养状况。术后早期可选择短肽类EN制剂。当病人术后肛门恢复排气，肠道消化吸收功能正常，可选用整蛋白制剂TP或TPF。TPF营养成分更为全面，而TP较TPF价格低。如病人经济条件允许，此时应选用TPF。
Abstract:
Objective: To compare the effects of different types of enteral nutrition (EN) on nutritional status and tolerance of patients with gastric cancer after operation. Methods: The data of those patients who were diagnosed gastric cancer that admitted to Gastrointestinal Surgery Department of the First Affiliated Hospital of Anhui Medical University from November 2017 to February 2021 were collected. Blood indicators（total protein, albumin, prealbumin, hemoglobin) before operation, before EN, after EN, fasting time, abdominal cavity drainage extubation time, EN start time, EN use time, postoperative hospital stay and cost were analyzed. Results: A total of 125 patients were enrolled who were divided into SP (28 cases) group, TPF (26 cases) group, and TP (71 cases) group. The results of total protein, albumin, prealbumin and hemoglobin were statistically different before and after enteral nutrition (P < 0.05). Additionally, the enteral nutrition cost of the three groups was statistically different (P < 0.05). There were no significant fifferences in the results of total protein, albumin, albumin and hemoglobin before and after enteral nutrition, fasting time, abdominal cavity drainage extubation time, EN start time, EN use time, postoperative hospital stay among the three groups (P > 0.05). The tolerance of SP was the best in three groups. The cost of enteral nutrition from high to low was SP, TPF and TP, respectively. Conclusion: SP, TPF and TP can improve the nutritional status of postoperative patients with gastric cancer after operation. Short peptide enteral nutrition should be selected in the early phase after operation. TP or TPF can be used when anal exhaust is restored and intestinal digestion and absorption function is normal. TPF is more comprehensive in nutrition, while TP is cheaper than TPF. If the patient's economic conditions allows, TPF should be used at this time.

参考文献/References:


[1]Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
[2] ASPEN Board of directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adults and pediatric patients. JPEN J Parenter Enteral Nutr, 2002,26(1 Suppl): 1SA-138SA.
[3] Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr, 2017, 36(3):623-650.
[4] Arabi YM, Reintam Blaser A, Preiser JC. When and how to manage enteral feeding intolerance?. Intensive Care Med, 2019,45(7):1029-1031.
[5] Reintam Blaser A, Deane AM, Preiser JC, et al. Enteral Feeding Intolerance: Updates in Definitions and Pathophysiology. Nutr Clin Pract, 2021,36(1):40-49.
[6] McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and assessment of nutrition support therapy in the Adult critically ill patient: Society for Critical Care Medicine (SCCM) and American Society for Parentral and Enteral Nutrition(ASPEN). JPEN J Parenter Enteral Nutr,2016,40(2):159-211.
[7] 邸 洁, 尚昱君, 王素梅, 等. 基于喂养流程的脓毒症病人早期肠内营养耐受性的评估与管理. 肠外与肠内营养, 2020, 27(1):50-55.
[8] Li K, Xu Y, Hu Y, et al. Effect of enteral immunonutrition on immune, inflammatory markers and nutritional status in gastric cancer patients undergoing gastrectomy: A randomized double blinded controlled trial. J Invest Surg, 2020, 33(10): 950-959.
[9] Cheng Y, Zhang J, Zhang L, et al. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol, 2018, 18(1):11.
[10] Kubota T, Shoda K, Konishi H, et al. Nutrition update in gastric cancer surgery. Ann Gastroenterol Surg, 2020, 4(4):360-368.
[11] Jeong O, Ryu SY, Jung MR, et al. The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma. Gastric Cancer, 2014, 17(2):324-331.
[12] Chen W, Zhang Z, Xiong M, et al. Early enteral nutrition after total gastrectomy for gastric cancer. Asia Pac J Clin Nutr, 2014, 23(4):607-611.
[13] Klek S, Kulig J, Sierzega M, et al. The impact of immunostimulating nutrition on infectious complications after upper gastrointestinal surgery: a prospective, randomized, clinical trial. Ann Surg, 2008, 248(2): 212-220.
[14] Yan X, Zhou FX, Lan T, et al. Optimal postoperative nutrition support for patients with gastroin- testinal malignancy: A systematic review and meta-analysis. Clin Nutr, 2017, 36(3): 710-721.
[15] Nikniaz Z, Somi MH, Nagashi S, et al. Impact of Early Enteral Nutrition on Nutritional and Immunological Outcomes of Gastric Cancer Patients Undergoing Gastrostomy: A Systematic Review and Meta-Analysis. Nutr Cancer, 2017, 69(5):693-701.
[16] McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutritionsupport therapyintheadult critically ill patient: Society of Critical Caremedicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr, 2009, 33:277-316.
[17] Gao L, Zhao Z, Zhang L, et al. Effect of early oral feeding on gastrointestinal function recovery in postoperative gastric cancer patients: a prospective study. J BUON, 2019, 24(1): 194-200.
[18] Blaser AR, Starkopf J, Kirsim?gi ?, et al. De nition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis. Acta Anaesthesiol Scand, 2014, 58(8):914-922.
[19] Hu B, Sun R, Wu A, et al. Prognostic value of prolonged feeding intolerance in predicting all-cause mortality in critically ill patients: a multicenter, prospective, observational study. JPEN J Parenter Enteral Nutr, 2019, 44 (5): 855-865.
[20] 叶向红, 宫雪梅, 王慧君, 等. 早期肠内营养耐受性分级干预在重症病人中的应用.肠外与肠内营养,2020,27(2):89-93.
[21] Shimizu K, Ogura H, Asahara T, et al. Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome: a preliminary study. Neurogastroenterol Motil, 2011,23(4):330-5, e157.
[22] Oshima T, Singer P, Pichard C. Parenteral or enteral nutrition: do you have the choice?. Curr Opin Crit Care, 2016, 22(4):292-298.
[23] Heyland DK, Schroter-Noppe D, Drover JW, et al. Nutrition support in the critical care setting: current practice in canadian ICUs-opportunities for improvement?. JPEN J Parenter Enteral Nutr,2003, 27(1):74-83.

相似文献/References:

[1]潘灵爱,黄晓波,王艺萍.超声监测胃残余量在风心病合并恶液质病人术后肠内营养中的应用[J].肠外与肠内营养杂志,2018,(01):43.[doi:10.16151/j.1007-810x.2018.01.012]
　PAN Ling-ai,HUANG Xiao-bo,WANG Yi-ping.Application of bedside ultrasound monitoring of gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support[J].PARENTERAL & ENTERAL NUTRITION,2018,(03):43.[doi:10.16151/j.1007-810x.2018.01.012]
[2]闫凯旋,曹 铖,杨 磊,等.糖尿病专用型肠内营养混悬液对重型脑损伤病人 营养指标以及免疫功能的影响[J].肠外与肠内营养杂志,2018,(02):76.[doi:10.16151/j.1007-810x.2018.02.004]
　YAN Kai-xuan,CAO Cheng,YANG Lei,et al.Effects of TPF-DM on Nutrient Indexes and Immune Function in Severe Traumatic Brain Injury Patients[J].PARENTERAL & ENTERAL NUTRITION,2018,(03):76.[doi:10.16151/j.1007-810x.2018.02.004]
[3]高学金,章 黎,田 锋,等.床边电磁导航下放置鼻肠管在胃肠外科重症病人中的作用[J].肠外与肠内营养杂志,2018,(05):277.[doi:10.16151/j.1007-810x.2018.05.006]
　GAO Xue-jin,ZHANG Li,TIAN Feng,et al.Electromagnetically guided bedside placement of nasojejunal feeding tubes in gastrointestinal critical ill surgical patients[J].PARENTERAL & ENTERAL NUTRITION,2018,(03):277.[doi:10.16151/j.1007-810x.2018.05.006]
[4]高 卉,吕蓓蓓,李 琳,等.围手术期口服营养补充对老年股骨转子间骨折术后营养状况及生活质量的影响[J].肠外与肠内营养杂志,2018,(05):296.[doi:10.16151/j.1007-810x.2018.05.010]
　GAO Hui,L? Bei-bei,LI Lin,et al.Effects of perioperative oral nutrition supplement on nutritional status and quality of life after femoral intertrochanteric fracture in the elderly[J].PARENTERAL & ENTERAL NUTRITION,2018,(03):296.[doi:10.16151/j.1007-810x.2018.05.010]
[5]赵成.肠道菌群研究促进膳食纤维的应用[J].肠外与肠内营养杂志,2019,(01):8.[doi:10.16151/j.1007-810x.2019.01.003]
[6]郑嘉烁.血流动力学不稳定的休克病人不宜早期使用肠内营养[J].肠外与肠内营养杂志,2019,(01):16.[doi:10.16151/j.1007-810x.2019.01.007]
[7]解好好.高能量密度肠内营养：有益或有害？[J].肠外与肠内营养杂志,2019,(01):20.[doi:10.16151/j.1007-810x.2019.01.009]
[8]王绪林,范朝刚,李 杨,等.血清25-(OH)维生素D水平与进展期胃癌新辅助化疗后生存时间的相关性研究[J].肠外与肠内营养杂志,2019,(01):35.[doi:10.16151/j.1007-810x.2019.01.014]
　WANG Xu-lin,FAN Chao-gang,LI Yang,et al.Correlations between serum 25(OH) vitamin D levels and the prognosis of advanced gastric cancer patients with neoadjuvant chemotherapy[J].PARENTERAL & ENTERAL NUTRITION,2019,(03):35.[doi:10.16151/j.1007-810x.2019.01.014]
[9]夏 焱,吴圣楠,刁英飞,等.低热量高蛋白肠内营养对急性脑梗死病人营养指标及并发症的 影响[J].肠外与肠内营养杂志,2019,(03):161.[doi:DOI : 10.16151/j.1007-810x.2019.03.007]
　XIA Yan,WU Sheng-nan,DIAO Ying-fei,et al.Effect of low calorie and high protein enteral nutrition on nutritional indexes and complications in patients with acute cerebral infarction[J].PARENTERAL & ENTERAL NUTRITION,2019,(03):161.[doi:DOI : 10.16151/j.1007-810x.2019.03.007]
[10]徐令婕,毕清泉,郑海燕,等.营养状况对胃癌术后化疗耐受性及负性情绪的影响[J].肠外与肠内营养杂志,2019,(03):166.[doi:DOI : 10.16151/j.1007-810x.2019.03.008]
　XU Ling-jie,BI Qing-quan,ZHENG Hai-yan,et al.Effects of nutritional status on postoperative chemotherapy tolerance and negative emotion in patients with gastric cancer[J].PARENTERAL & ENTERAL NUTRITION,2019,(03):166.[doi:DOI : 10.16151/j.1007-810x.2019.03.008]
[11]符小婧,何书杏,苏连红,等.糖尿病专用肠内营养制剂对胃癌术后病人应激性血糖波动和胰 岛素抵抗的影响[J].肠外与肠内营养杂志,2021,(04):225.[doi:10.16151/j.1007-810x.2021.04.008]
　FU Xiao-jing,HE Shu-xing,SU Lian-hong,et al.Influence of diabetes-specific enteral nutrition on stress-induced blood glucose fluctuations and insulin resistance in postoperative patients with gastric cancer[J].PARENTERAL & ENTERAL NUTRITION,2021,(03):225.[doi:10.16151/j.1007-810x.2021.04.008]

备注/Memo

备注/Memo:
基金项目 ：2020年度安徽高校自然科学研究项目（KJ2020A0191） 作者简介 ：汤亲青，副主任医师，医学博士，主要从事普通外科的研究工作。E-mail：tangqinqing@aliyun.com
更新日期/Last Update: 1900-01-01