胃癌术后早期应用不同肠内营养剂的对比研究

发布时间：2018-02-01 14:57

  本文关键词： 胃癌 肠内营养 短肽　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的:目前,肠内营养(enteral nutrition,EN)应用于外科术后病人的作用日益被临床工作者关注。据全国癌症登记中心显示,2015年我国胃癌发病例数近68万,仅次于肺癌排名第二位,对于适宜手术的患者,手术切除是首选的治疗方式。肿瘤自身存在代谢异常,而手术对机体又是一种打击,这导致术后患者的营养状况往往不理想。我国肠内营养制剂分类繁杂,对于不同肠内营养剂应用与胃癌术后患者的效果尚缺少横向比较,本研究旨在对比研究两种临床应用的肠内营养剂(短肽型肠内营养剂百普力与整蛋白型肠内营养剂能全力)应用于胃癌手术后的临床疗效等有何差异。方法:共纳入90例胃癌术后患者,将纳入的患者随机平分为两组:短肽型肠内营养剂组(短肽组)与整蛋白型肠内营养剂组(整蛋白组)。对比研究两组应用不同EN制剂的效果与不良反应等有何差异,其中短肽组给予百普力(短肽型肠内营养剂),整蛋白组给予能全力(整蛋白型肠内营养剂)。于术前1天、术后第1天、术后第8天分别抽取各组患者的外周血,检测其血液指标,其中包括淋巴细胞计数(lymphocyte count,LYC)、血红蛋白(hemoglobin,HGB)、白蛋白(albumin,ALB)、前白蛋白(Prealbumin,PA),并观察术后胃肠道功能恢复时间(排气时间)、术后并发症(切口感染、肺部感染、吻合口瘘)的发生率、肠内营养支持费用,以及肠内营养相关并发症(腹泻、腹胀、恶心呕吐)的发生情况。数据的统计分析使用软件SPSS19.0,以P0.05为差异有统计学意义。结果:1.血液指标两组术前一天比较三种营养指标ALB、PA、HGB与LYC值无显著差异(P0.05)。短肽组,术后第8天与术后1天相比,ALB、PA、HGB与LYC值明显上升(P0.05)。整蛋白组,术后第8天与术后1天相比,ALB、PA、HGB与LYC值明显上升(P0.05)。组间对比,术后第8天短肽组与整蛋白组三种营养指标ALB、PA、HGB与LYC值无统计学差异(P0.05)。2.肠内营养相关不良反应:短肽组,发生腹泻6例(13.6%),腹胀4例(9.1%),恶心呕吐3例(6.8%)。整蛋白组,发生腹泻14例(31.1%),腹胀13例(28.9%),恶心呕吐2例(4.4%)。组间相比腹泻发生率,短肽组低于整蛋白组(P0.05),其差异具有统计学意义。腹胀发生率,短肽组低于整蛋白组(P0.05),其差异具有统计学意义。其他不良反应发生率无统计学差异(P0.05)3.术后并发症短肽组,术后有7例(15.9%)发生术后并发症;整蛋白组有9例(20%)发生并发症;两组比较无统计学差异(P0.05)。4.术后恢复排气时间:短肽组患者恢复肛门排气的时间为52.4±6.1h,整蛋白组患者恢复肛门排气的时间为52.7±6.4h,组间对比无显著性差异(P0.05),不具有统计学意义。5.肠内营养支持费用短肽组肠内营养支持平均费用为2216±137元,整蛋白组平均费用为1771±111元,组间对比有显著性差异(P0.05)。结论：1.短肽型肠内营养剂与整蛋白型肠内营养剂都可以明显改善胃癌术后患者的营养状态。2.胃癌术后早期应用短肽型肠内营养剂的不良反应发生率要低于整蛋白型肠内营养剂。3.短肽型肠内营养剂对胃癌术后患者并发症以及胃肠道功能恢复的时间影响较之与整蛋白型肠内营养剂并无差异,从经济学的角度出发,考虑到短肽型肠内营养剂的支持费用明显高于整蛋白型肠内营养剂,对于胃癌术后患者可先用短肽型肠内营养剂,待患者恢复排气后逐渐改为整蛋白型肠内营养剂。
[Abstract]:Background and objective: at present, enteral nutrition (enteral, nutrition, EN) applied to the patients after surgery effect has been clinical workers attention. According to the National Cancer Registration Center shows that in 2015 China's nearly 680 thousand cases of gastric cancer, lung cancer ranked second, suitable for surgery, surgical resection is preferred treatment of tumor. Their metabolic abnormalities, and surgery on the body is a blow, which leads to postoperative nutritional status of patients is not ideal in China. Enteral nutrition for patients with complex classification, the effect of different enteral nutrition of patients with gastric carcinoma is still a lack of horizontal comparison, this study is to compare the research two kinds of clinical application of enteral nutrition (Short Peptide Enteral Nutrition Powder and Intacted Protein Enteral Nutrition Powder to Peptison) what is the difference in gastric cancer after surgery clinical curative effect. Methods: a total of 90 cases In patients with gastric cancer after operation, the patients were randomly divided into two groups: Short Peptide Enteral Nutrition Powder group (short peptide group) and Intacted Protein Enteral Nutrition Powder group (whole protein group). Comparison of two groups with different formulations of EN effect and adverse reaction of the difference in the peptide group was given Peptison (Short Peptide Enteral Nutrition Powder), the whole protein group to give (Intacted Protein Enteral Nutrition Powder). On the 1 day before surgery, after first days, eighth days after surgery respectively. Peripheral blood samples were collected from each group of patients, the detection of blood parameters, including lymphocyte count (lymphocyte, count, LYC), hemoglobin (hemoglobin, HGB), albumin (albumin, ALB), prealbumin (Prealbumin, PA), and observe the time of postoperative recovery of gastrointestinal function (exhaust), postoperative complications (wound infection, pulmonary infection, anastomotic fistula) the incidence of enteral nutrition and enteral nutrition related costs, and 鍙戠棁(鑵规郴,鑵硅儉,鎭跺績鍛曞悙)鐨勫彂鐢熸儏鍐，

本文编号：1482136