全腸外營養及早期腸內營養在胃癌全胃切除術后患者中的對比研究_《中國普外基礎與臨床雜志》

作者：

袁琮韋華 , 李俊生 , 嵇振嶺 , 張亞男 , 陳衛東 , 鞠興唐

東南大學附屬中大醫院普外科(南京 210009);

關鍵詞：

胃癌全胃切除術腸內營養全腸外營養

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　　探討胃癌全胃切除術后的患者分別進行早期腸內營養(EEN)或全腸外營養(TPN)支持對患者術后恢復的影響。
　　方法　回顧性分析我院2006年6月至2009年8月期間行全胃切除的患者86例，其中術后行TPN者31例(TPN組)，行EEN者55例(EEN組)。TPN 組通過上腔靜脈（頸內或鎖骨下）穿刺置管，經靜脈給予營養支持； EEN組術中留置鼻腸管，術后第2天開始逐漸增加腸內營養（瑞素），并逐步減少腸外營養，至術后3~5 d達到全腸內營養。檢測術后血清白蛋白水平，記錄術后通氣與排便時間、經口進食時間、住院時間以及各種并發癥的發生情況。
　　結果　TPN組與EEN組比較，術后血漿白蛋白、術后通氣時間、排便時間、并發癥發生率及住院時間差異均無統計學意義（P gt;0.05）。在進流質時間上EEN組反而晚于TPN組,差異有統計學意義（P=0.004）。
　　結論　經TPN進行營養支持與鼻腸管進行腸內營養均可作為全胃切除術后的營養支持方式，兩種方式的恢復情況及并發癥發生情況無明顯差異，可以根據患者術前營養狀態及合并癥決定是否行鼻腸管置入。

引用本文： 袁琮韋華,李俊生,嵇振嶺,張亞男,陳衛東,鞠興唐. 全腸外營養及早期腸內營養在胃癌全胃切除術后患者中的對比研究. 中國普外基礎與臨床雜志, 2010, 17(4): 357-362. doi: 復制

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5.	Doglietto GB, Papa V, Tortorelli AP, et al. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial [J]. Arch Surg, 2004; 139(12): 1309-1313.
6.	Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature [J]. J Gastrointest Surg, 2008; 12(4): 739-755.
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8.	Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer [J]. Clin Nutr, 2005; 24(1): 55-65.
9.	Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial [J]. Ann Surg, 1995; 222(1): 73-77.
10.	〖JP3〗李江, 劉斌, 侯宇, 等. 腹部外科術后早期腸內營養的臨床研究與應用 [J]. 中國普外基礎與臨床雜志, 2006; 13(3): 355-357.
11.	Woodcock NP, Zeigler D, Palmer MD, et al. Enteral versus parenteral nutrition: a pragmatic study [J]. Nutrition, 2001; 17(1): 53-55.
12.	Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980; 139(1): 160-167.
13.	Detsky AS, Baker JP, O’Rourke K, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery [J]. JPEN J Parenter Enteral Nutr, 1987; 11(5): 440-446.
14.	Meguid MM, Debonis D, Meguid V, et al. Complications of abdominal operations for malignant disease [J]. Am J Surg, 1988; 156(5): 341-345.
15.	Middleton MH, Nazarenko G, Nivison-Smith I, et al. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals [J]. Intern Med J， 2001; 31(8): 455-461.
16.	Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition [J]. Am J Clin Nutr, 1997; 66(3): 683-706.
17.	van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients [J]. N Engl J Med, 2001; 345(19): 1359-1367.
18.	Guedon C, Schmitz J, Lerebours E, et al. Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults [J]. Gastroenterology, 1986; 90(2): 373-378.〖HJ2〗[19]　Sedman PC, MacFie J, Palmer MD, et al. Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans [J]. Br J Surg, 1995; 82(12): 1663-1667.
19.	Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition [J]. Crit Care Med, 2001; 29(2): 242-248.
20.	Hu QG, Zheng QC. The influence of enteral nutrition in postoperative patients with poor liver function [J]. World J Gastroenterol, 2003; 9(4): 843-846.
21.	Soliani P, Dell’Abate P, Del Rio P, et al. Early enteral nutrition in patients treated with major surgery of the abdomen and the pelvis [J]. Chir Ital, 2001; 53(5): 619-632.
22.	Pearlstone DB, Lee JI, Alexander RH, et al. Effect of enteral and parenteral nutrition on amino acid levels in cancer patients [J]. JPEN J Parenter Enteral Nutr, 1995; 19(3): 204-208.
23.	傅少華，朱劍飛，孫慶宇. 66例老年胃癌患者全胃切除術后的營養支持 [J]. 蘇州大學學報(醫學版), 2007; 27(1): 147-148, 150.

1. 趙曉雷, 彭俊生. 不同營養支持方法在胃癌病人術后的應用 [J]. 腸外與腸內營養, 2007; 14(1): 32-34, 38.
2. 　吳國豪. 腫瘤患者營養不良的原因與危害 [J]. 中國實用外科雜志, 2002; 22(11): 644-646.
3. 　汪敏徽，侯維孝. 腸內營養在胃癌術后的臨床營養 [J]. 中華胃腸外科雜志, 2004; 7(4): 330-332.
4. 　Shastri YM, Shirodkar M, Mallath MK, et al. Endoscopic feeding tube placement in patients with cancer: a prospective clinical audit of 2 055 procedures in 1 866 patients [J]. Aliment Pharmacol Ther, 2008; 27(8): 649-658.
5. 　Doglietto GB, Papa V, Tortorelli AP, et al. Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial [J]. Arch Surg, 2004; 139(12): 1309-1313.
6. 　Mazaki T, Ebisawa K. Enteral versus parenteral nutrition after gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials in the English literature [J]. J Gastrointest Surg, 2008; 12(4): 739-755.
7. 　林偉, 陳金坤, 徐海健, 等. 全胃切除術后早期腸內營養對免疫狀態的影響 [J]. 齊齊哈爾醫學院學報, 2007; 28(10): 1178-1179.
8. 　Farreras N, Artigas V, Cardona D, et al. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer [J]. Clin Nutr, 2005; 24(1): 55-65.
9. 　Reissman P, Teoh TA, Cohen SM, et al. Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial [J]. Ann Surg, 1995; 222(1): 73-77.
10. 　〖JP3〗李江, 劉斌, 侯宇, 等. 腹部外科術后早期腸內營養的臨床研究與應用 [J]. 中國普外基礎與臨床雜志, 2006; 13(3): 355-357.
11. 　Woodcock NP, Zeigler D, Palmer MD, et al. Enteral versus parenteral nutrition: a pragmatic study [J]. Nutrition, 2001; 17(1): 53-55.
12. 　Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980; 139(1): 160-167.
13. 　Detsky AS, Baker JP, O’Rourke K, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery [J]. JPEN J Parenter Enteral Nutr, 1987; 11(5): 440-446.
14. 　Meguid MM, Debonis D, Meguid V, et al. Complications of abdominal operations for malignant disease [J]. Am J Surg, 1988; 156(5): 341-345.
15. 　Middleton MH, Nazarenko G, Nivison-Smith I, et al. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals [J]. Intern Med J， 2001; 31(8): 455-461.
16. 　Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition [J]. Am J Clin Nutr, 1997; 66(3): 683-706.
17. 　van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients [J]. N Engl J Med, 2001; 345(19): 1359-1367.
18. 　Guedon C, Schmitz J, Lerebours E, et al. Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults [J]. Gastroenterology, 1986; 90(2): 373-378.〖HJ2〗[19]　Sedman PC, MacFie J, Palmer MD, et al. Preoperative total parenteral nutrition is not associated with mucosal atrophy or bacterial translocation in humans [J]. Br J Surg, 1995; 82(12): 1663-1667.
19. 　Braga M, Gianotti L, Gentilini O, et al. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition [J]. Crit Care Med, 2001; 29(2): 242-248.
20. 　Hu QG, Zheng QC. The influence of enteral nutrition in postoperative patients with poor liver function [J]. World J Gastroenterol, 2003; 9(4): 843-846.
21. 　Soliani P, Dell’Abate P, Del Rio P, et al. Early enteral nutrition in patients treated with major surgery of the abdomen and the pelvis [J]. Chir Ital, 2001; 53(5): 619-632.
22. 　Pearlstone DB, Lee JI, Alexander RH, et al. Effect of enteral and parenteral nutrition on amino acid levels in cancer patients [J]. JPEN J Parenter Enteral Nutr, 1995; 19(3): 204-208.
23. 　傅少華，朱劍飛，孫慶宇. 66例老年胃癌患者全胃切除術后的營養支持 [J]. 蘇州大學學報(醫學版), 2007; 27(1): 147-148, 150.

《中國普外基礎與臨床雜志》

全腸外營養及早期腸內營養在胃癌全胃切除術后患者中的對比研究

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《中國普外基礎與臨床雜志》

全腸外營養及早期腸內營養在胃癌全胃切除術后患者中的對比研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料