高克锋+杨宁+李兴

[摘要]目的 對比分析两种不同的营养方式对食管癌手术患者胃肠功能的影响。方法 回顾性分析2016年6月～2017年1月我院行外科手术切除术的126例食管癌患者的临床资料，根据患者术后营养方式的不同，分为混合营养组（EN+PN组）与肠外营养组（PN组），每组各63例。术前1 d、术后第3天及第8天清晨取静脉血进行生化检测，并计算体重下降值。术后观察患者肛门排气时间、排便时间、术后住院时间、消化道症状及并发症等情况。结果 术前1 d，两组患者的血清白蛋白、前白蛋白、血红蛋白比较，差异无统计学意义（P>0.05）。与术前1 d比较，术后第3天与第8天，两组患者的血清白蛋白、前白蛋白、血红蛋白显著降低，差异有统计学意义（P<0.05）。而与术后第3天比较，术后第8天两组患者的血清白蛋白、前白蛋白、血红蛋白显著升高，差异有统计学意义（P<0.05）。术后第8天，EN+PN组前白蛋白、血红蛋白水平均明显高于PN组，差异有统计学意义（P<0.05）。术后EN+PN组肛门排气时间、排便时间、住院时间均明显短于PN组，差异有统计学意义（P<0.05）。EN+PN组体重下降值明显低于PN组，差异有统计学意义（P<0.05）。EN+PN组消化道症状及术后并发症发生率均明显低于PN组，差异有统计学意义（P<0.05）。结论 早期肠内肠外混合营养方式有利于食管癌患者术后尽快恢复肠道功能，并且可以缩短患者住院时间，不良反应少，值得推广应用。

[关键词]食管癌；肠内营养；肠外营养；胃肠道功能

[中图分类号] R473.6 [文献标识码] A [文章编号] 1674-4721（2017）08（c）-0042-04

[Abstract]Objective To compare and analyze the effect of two different nutritional modes on gastrointestinal function in patients with esophageal carcinoma.Methods Retrospective analysis of the clinical data of 126 patients with esophageal cancer who underwent surgical resection in our hospital from June 2016 to January 2017.The patients were divided into mixed nutrition group （EN+PN group） and parenteral nutrition group （PN group） according to the different postoperative nutrition modes of patients，63 cases in each group.The blood was taken at the the morning of preoperative 1 day，third days and eight days after operation for biochemical detection，and the weight loss was calculated.The anal exhaust time，defecation time，postoperative hospital stay，gastrointestinal symptoms and complications were observed after operation.Results The serum albumin，prealbumin and hemoglobin in the two groups were compared with preoperative 1 day，and the differences were not statistically significant （P>0.05）.The serum albumin，prealbumin and hemoglobin were significantly reduced in the two groups on the third days and eight days after operation compared with preoperative 1 day，and the differences were statistically significant （P<0.05）.While the serum albumin，prealbumin and hemoglobin were significantly higher in the two groups on the eight days after operation compared with the third day after operation，and the differences were statistically significant （P<0.05）.On the eighth day after operation，the levels of albumin and hemoglobin in EN+PN group were significantly higher than that of PN group，and the differences were statistically significant（P<0.05）.After surgery，the anal exhaust time，defecation time and hospital time of the EN+PN group were significantly shorter than the PN group，and the weight loss was significantly lower than the PN group，the differences were statistically significant （P<0.05）. The incidence of digestive tract symptoms and postoperative complications of EN+PN group were significantly lower than that of PN group，and the differences were statistically significant （P<0.05）.Conclusion Early enteral parenteral nutrition is beneficial to the recovery of intestinal function as soon as possible after the operation of esophageal carcinoma，and it can shorten the time of hospitalization and less adverse reactions.It is worthy of popularization and application.endprint

[Key words]Esophageal cancer；Enteral nutrition；Parenteral nutrition；Gastrointestinal function

食管癌是常见消化道恶性肿瘤之一，起病隐匿，在全球范围内死亡率居第6位[1]。食管癌临床表现为进行性吞咽困难，患者常伴有营养不良，目前最有效的根治方法是外科手术切除[2-3]。食管癌手术创伤较大，且患者术后呈高代谢状态，机体自我保护机制反应较弱，营养需求较高。因此，术后营养支持是提高手术成功率的关键，对维持患者术后正常生理功能及减少并发症有重要意义。临床常用营养方式包括肠外营养（PN）和肠内营养（EN）。肠外营养对食管癌患者的营养支持有重要作用，但是长期大量的肠外营养对肠黏膜的结构和功能有一定损伤，易引起肠道菌群失调[4]。肠内……