摘要
目的探讨术后早期肠内营养对老年全胃切除术后患者营养状态、免疫功能、感染性并发症、住院时间及营养支持费用的影响。方法57例老年全胃切除术后患者分为常规营养组、早期肠外营养组(肠外营养组)和早期肠内营养组(肠内营养组)。于手术前后检测营养和免疫指标,观察术后感染性并发症,统计住院天数及营养支持费用。结果术后9d,肠外营养组的血清白蛋白、转铁蛋白、前白蛋白、CD3、CD4、CD4/CD8分别为(34.3±3.5)g/L、(1.7±0.2)g/L、(258.8±20.2)mg/L、(39.7±5.4)%、(34.3±4.0)%和(1.5±0.3),肠内营养组分别为(33.9±3.1)g/L、(1.7±0.2)g/L、(260.5±24.7)mg/L、(42.8±6.5)%、(37.2±4.5)%和(1.7±0.2),均显著高于常规营养组的(29.5±3.0)g/L、(1.3±0.2)g/L、(235.4±13.9)mg/L、(34.8±5.0)%、(30.4±4.4)%和(1.2±0.2),差异均有统计学意义(P<0.01);肠内营养组的CD3、CD4、CD4/CD8水平显著高于肠外营养组(P<0.05)。肠外营养组感染性并发症少于常规营养组,高于肠内营养组。肠外营养组和肠内营养组的住院天数分别为(14.4±2.1)d和(11.2±1.8)d,均显著少于常规营养组的(19.5±3.3)d,差异均有统计学意义(均为P<0.01),而肠内营养组又显著少于肠外营养组(P<0.05)。肠内营养组营养支持费用为(1540.9±164.7)元,显著少于肠外营养组的(3986.4±456.5)元(P<0.01)。结论对于老年全胃切除术后患者,早期肠外营养和早期肠内营养均可行,但早期肠内营养可作为第一选择。
Objective To explore the clinical effect of postoperative early enteral nutrition in the elderly patients with total gastrectomy. Methods Fifty seven elderly patients with total gastrectomy were divided into postoperative routine nutrition（PRN）, postoperative early parenteral nutrition（PEPN）, and postoperative early enteral nutrition （PEEN） groups. The levels of serum albumin（ALB）, transferrin（TF）, pre-albumin（PA）, CD3, CD4, CD8, CD4/CD8 were detected 1 day before（PRED 1 ） and 9 days after（POD 9 ） operation, and the postoperative infectious complications were observed , and the length of hospital stay（LOS） and the cost of nutritional support were determined. Results The levels of AL.B, TF, PA, CD3, CD4 and CD4/CD8 on POD 9 were （34.3±3.5）g/L, （1.7±0.2）g/L, （258.8_±20.2）mg/L,（39.7±5.4） %,（34.3±4.0）% and （1.5± 0.3） in PEPN as well as （33.9±3. 1）g/L, （1.7±0.2）g/L, （260.5_±24.7）mg/L, （42.8±6.5）%, （37.2±4.5）% and （1.7±0.2） respectively, which were all significantly lower than （29.5±3.0）g/ L, （1.3±0.2）g/L, （235.4±13.9）mg/L, （34.8±5.0）%, （30.4±4.4）% and （1.2±0.2） in RN group （all P〈0.01）, The levels of CD3, CD4 and CD4/CD8 were significantly higher in PEEN group than in PEPN group（P〈0.05）. The eases of postoperative infectious complications in RT, PEPN and PEEN groups were the 7, 5 and 2 respectively. The length of stay（LOS） in PEPN group（（ 14.4± 2. 1）d] and PEEN group[（11.2± 1.8）d] were significantly shorter than that in TF group[（19.5± 3.3）d] （all P〈0.01）, the LOS in PEEN group was significantly shorter than in PEEN group（ P〈 0.05）. The costs of nutritional support were significantly lower in PEEN group[CNY（1540.9± 164.7）] than in PEPN group[CNY（3986.4± 456.5）] （P〈0.01）. Conclusions Both PEPN and PEEN could be chosen as means of postoperative nutritional support for elderly patients with total gastrectomy, but PEEN should be the first choice because of its better immunological improvement, less postoperative infectious complications, shorter LOS, and lower cost of nutritional support as compared with PEPN.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2005年第10期745-748,共4页
Chinese Journal of Geriatrics
关键词
胃切除术
肠道营养
Gastrectomy
Enteral nutrition
