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目的探讨食管癌、贲门癌术后早期肠内营养的安全性、可行性和临床疗效。方法选择56例食管、贲门癌手术患者。随机分为肠内营养组(EN组n=30)和肠外营养组(PN组n=26),所有病例在术前、术后第1、8天分别测血清总蛋白、白蛋白、前白蛋白、转铁蛋白、淋巴细胞计数、尿素氮、肌酐、血糖、谷丙转氨酶、血红蛋白和电解质(K+、Na+、Cl-)。临床观察营养支持后有无消化道症状,胃肠功能恢复情况,有无吻合口瘘及测体质量。结果所有病例在研究期间无死亡、无明显肝肾功能改变、无吻合口瘘。营养支持后EN组白蛋白、前白蛋白、转铁蛋白和淋巴细胞计数水平明显升高(P<0.01)。营养支持后EN组与PN组对比,白蛋白、前白蛋白、转铁蛋白和淋巴细胞计数明显增高(P<0.001)。临床观察生命体征及肛门恢复排气时间较PN组显著缩短时间(P<0.001),体质量下降减慢。结论食管癌、贲门癌术后早期肠内营养安全可行,既能改善营养状态,维护和促进胃肠道功能,又能提高机体免疫功能,减少术后并发症的发生。
Objective To investigate the safety, feasibility and clinical efficacy of early postoperative enteral nutrition in patients with esophageal and cardiac cancer. Methods 56 cases of esophageal and cardiac surgery patients were selected. The patients were randomly divided into enteral nutrition group (n = 30 in EN group) and parenteral nutrition group (n = 26 in PN group). The serum total protein, albumin, Albumin, transferrin, lymphocyte count, urea nitrogen, creatinine, blood glucose, alanine aminotransferase, hemoglobin and electrolytes (K +, Na +, Cl-). Clinical observation of nutritional support with or without gastrointestinal symptoms, gastrointestinal function recovery, with or without anastomotic leakage and test body mass. Results All the cases had no death during the study, no obvious change of liver and kidney function, no anastomotic fistula. After nutritional support, albumin, prealbumin, transferrin and lymphocyte counts were significantly increased in EN group (P <0.01). After nutritional support, the albumin, prealbumin, transferrin and lymphocyte counts were significantly higher in EN group compared with PN group (P <0.001). Clinical observation of vital signs and anus recovery exhaust time significantly shorter than the PN group (P <0.001), body weight decreased slowly. Conclusion Early postoperative enteral nutrition in esophageal and cardia cancer is safe and feasible. It can not only improve nutritional status, maintain and promote gastrointestinal function, but also improve immune function and reduce postoperative complications.