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目的:探讨胃癌全胃切除术后早期肠内营养(EN)和全肠外营养(PN)对术后营养状况和免疫功能等状况恢复的影响。方法:50例胃癌全胃切除术后患者随机分为EN组和PN组,每组各25例。EN组术中放置空肠造口管,术后24h以内管喂肠内营养液肠内高营养多聚合剂(能全力),PN组给予等氮、等热量的标准PN,总热量为125kJ(/kg·d)术前1d、术后第1、10d观察并比较两组病人手术前、后的营养和免疫指标、术后肠鸣音恢复、肛门排气时间和并发症发生的情况。结果:所有病例无手术死亡、无严重并发症发生;两组病人术后营养支持的营养及免疫指标明显改善(P<0.05),EN组前白蛋白和免疫指标较PN组明显提高(P<0.05);EN组较PN组术后胃肠功能恢复的更早,并发症的发生率亦明显减低,同时住院时间短。结论:胃癌全胃切除术后早期予肠内营养安全、有效,既能促进胃肠道功能早期恢复,又可改善患者术后营养状况和免疫功能,是值得推广的营养支持方式。
Objective: To investigate the effect of early enteral nutrition (EN) and total parenteral nutrition (PN) on recovery of nutritional status and immune function after total gastrectomy for gastric cancer. Methods: Fifty patients with total gastrectomy for gastric cancer were randomly divided into EN group and PN group, with 25 cases in each group. In EN group, the jejunostomy tube was placed intraoperatively, and the enteral nutrition solution was supplemented with enteral nutrition solution (fully capable) within 24 hours after operation. The PN group was given the standard PN equal to the calorific value and the total calorie was 125 kJ / kg · d) 1 d before operation and 1, 10 days after operation. The nutritional and immune indexes before and after operation, postoperative bowel sounds recovery, anal exhaust time and complications were observed and compared between the two groups. Results: There was no operative death and no serious complication occurred in all cases. Nutritional and immune indices of postoperative nutritional support were significantly improved in both groups (P <0.05). Prealbumin and immune index in EN group were significantly higher than those in PN group (P < 0.05). The EN group had earlier gastrointestinal function recovery than the PN group, the incidence of complications was also significantly reduced, and the hospitalization time was short. Conclusion: The early enteral nutrition after total gastrectomy for gastric cancer is safe and effective. It not only can promote the early recovery of gastrointestinal function, but also can improve the postoperative nutritional status and immune function. It is worth promoting the nutritional support.