结直肠癌患者围术期营养支持治疗的临床疗效研究

发布时间：2018-01-18 02:09

本文关键词：结直肠癌患者围术期营养支持治疗的临床疗效研究　出处：《广西中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:比较结直肠癌患者围术期应用肠外全合一营养液联合肠内营养支持治疗与单瓶滴注肠外营养液制剂联合肠内营养支持治疗的临床疗效及其优势。方法:本研究收集了广西中医药大学附属瑞康医院自2014年1月至2016年1月拟实施外科手术治疗的结直肠癌患者临床病例资料共52例,随机分为肠外全合一营养液联合肠内营养支持治疗26例和单瓶滴注肠外营养液制剂联合肠内营养支持治疗26例。观察应用两种营养支持治疗方式后患者围术期的各项实验室及临床指标和术后并发症发生率。结果:除对照组2例患者终止试验外,其余均按计划完成。两组患者的临床一般资料和疾病资料的基线基本一致,差异无统计学意义(P0.05),具有可比性。两组患者入院时血清白蛋白、血清前白蛋白、血红蛋白、总淋巴细胞计数差异无统计学意义,具有可比性(P0.05)。血清白蛋白入院时:治疗组为24.73±2.93g/L,对照组25.70±4.24g/L,差异无统计学意义(t=-0.941 P=0.352 P0.05);术前第1天:治疗组为31.15±3.16g/L,对照组30.17±4.51g/L,差异无统计学意义(t=0.356 P=0.371P0.05);术后第1天:治疗组为30.23±4.15g/L,对照组28.96±2.77g/L,差异无统计学意义(t=1.266 P=0.212 P0.05);术后第3天:治疗组为34.15±5.61g/L,对照组31.33±6.65g/L,差异无统计学意义(t=1.625P=0.111 P0.05);术后第7天:治疗组为39.42±4.20g/L,对照组36.79±3.78g/L,差异有统计学意义(t=2.324 P=0.024 P0.05);血清前白蛋白入院时:治疗组为0.15±0.03g/L;对照组0.16±0.02g/L,差异无统计学意义(t=-1.623 P=0.111 P0.05);术前第1天:治疗组为0.29±0.07g/L,对照组0.28±0.04g/L,差异无统计学意义(t=0.860 P=0.395 P0.05);术后第1天:治疗组为0.27±0.06g/L,对照组0.26±0.03g/L,差异无统计学意义(t=0.822 P=0.415 P0.05);术后第3天:治疗组为0.29±0.03g/L,对照组0.27±0.05g/L,差异无统计学意义(t=1.821 P=0.075 P0.05);术后第7天:治疗组为0.32±0.08g/L,对照组0.28±0.04g/L,差异有统计学意义(t=2.120 P=0.039 P0.05);血红蛋白入院时:治疗组为83.62±12.71g/L,对照组85.67±10.52g/L,差异无统计学意义(t=-0.619 P=0.539P0.05);术前第1天:治疗组为105.27±14.43g/L,对照组103.79±13.75g/L,差异无统计学意义(t=0.370 P=0.713 P0.05);术后第1天:治疗组为101.08±15.55g/L,对照组98.79±14.06g/L,差异无统计学意义(t=0.544 P=0.589 P0.05);术后第3天:治疗组为112.27±11.14g/L,对照组108.25±13.55g/L,差异无统计学意义(t=1.149 P=0.256 P0.05);术后第7天:治疗组为120.46±10.25g/L,对照组113.75±12.31g/L,差异有统计学意义(t=2.102 P=0.041 P0.05);血总淋巴细胞计数入院时:治疗组为1.51±0.18×109/L;对照组1.62±0.19×109/L,差异无统计学意义(t=-1.955 P=0.056 P0.05);术前第1天:治疗组为1.89±0.39×109/L;对照组1.72±0.23×109/L,差异无统计学意义(t=1.953 P=0.057P0.05);术后第1天:治疗组为1.82±0.29×109/L;对照组1.70±0.22×109/L,差异无统计学意义(t=1.597 P=0.117 P0.05);术后第3天:治疗组为2.06±0.23×109/L;对照组1.94±0.21×109/L,差异无统计学意义(t=1.944 P=0.058 P0.05);术后第7天:治疗组2.38±0.16×109/L;对照组2.12±0.22×109/L,差异有统计学意义(t=4.845 P=0.000 P0.05);两组患者在术后首次肛门排气时间(d):治疗组为2.46±0.75d,对照组3.07±1.01d(t=-2.443 P=0.018 P0.05);首次排便时间(d):治疗组4.08±1.02d,对照组5.71±1.27d(t=-5.038 P=0.000 P0.05);拆线时间(d):治疗组为7.70±1.44d,对照组为9.00±1.02d(t=-3.683P=0.001 P0.05);住院时间(d):治疗组为12.12±1.56d,对照组为16.04±1.65d(t=-8.643 P=0.000 P0.05)。治疗组的时间明显短于对照组,差异有统计学意义。两组术后并发症发生率:治疗组共有3/26例(6.0%):其中未出现吻合口瘘及切口感染,切口裂开1例(8.3%)、肺部感染1例(8.3%)、泌尿系感染1例(8.3%);对照组共有9/24例(18.0%):吻合口瘘1例(8.3%)、切口感染1例(8.3%)、切口裂开3例(25.0%)、肺部感染2例(16.7%)、泌尿系感染2例(16.7%);两组间发生率经统计学检验,差异有统计学意义(X2=4.612 P=0.032 P0.05)。结论:结直肠癌患者围术期应用肠外全合一营养液联合肠内营养支持治疗在促进患者术后胃肠功能恢复,改善营养状况、免疫功能及降低并发症发生率方面疗效优于对照组,对患者术后的快速康复有促进作用。
[Abstract]:Objective: To compare the results of perioperative application of intestinal cancer patients outside the all-in-one nutrient solution combined with enteral nutrition and intestinal therapy and single bottle infusion of parenteral nutrition formulations of nutrition in clinical efficacy and advantages of treatment. Methods: This study collected Rui Kang Hospital of Guangxi traditional Chinese Medical University from January 2014 to January 2016 to be the clinical data of patients with colorectal cancer surgery for a total of 52 patients were randomly divided into a total parenteral nutrient solution combined with enteral nutrition in the treatment of 26 cases of single bottle infusion and parenteral nutrition combined with enteral nutrition preparation in treatment of 26 cases. Observe the application of two kinds of nutritional support treatment after surgery the laboratory and clinical indicators and the incidence of postoperative complications. Results: in addition to the control group of 2 patients with the end of the experiment, the rest were completed according to plan. The general information and clinical data of two patients of the disease group The line is basically the same, the difference was not statistically significant (P0.05), comparable. Two serum albumin, serum albumin, hemoglobin, total lymphocyte count had no significant difference, comparable. Serum albumin (P0.05) at the time of admission: the treatment group was 24.73 + 2.93g/L, 25.70 + 4.24g/L control group, the difference was not statistically significant (t=-0.941 P=0.352 P0.05); first days before operation: the treatment group was 31.15 + 3.16g/L, 30.17 + 4.51g/L control group, the difference was not statistically significant (t=0.356 P=0.371P0.05); after first days, the treatment group is 30.23 + 4.15g/L, 28.96 + 2.77g/L control group, the difference was not statistically significant (t=1.266 P=0.212, P0.05); after third days of treatment group was 34.15 + 5.61g/L, 31.33 + 6.65g/L control group, the difference was not statistically significant (t=1.625P=0.111 P0.05); after seventh days, the treatment group is 39.42 + 4.20g/L, 36.79 + 3.78g/L control group, the difference was statistically Meaning (t=2.324 P=0.024 P0.05); serum prealbumin admission: the treatment group was 0.15 + 0.03g/L 0.16 + 0.02g/L; the control group, the difference was not statistically significant (t=-1.623 P=0.111 P0.05); first days before operation: the treatment group was 0.29 + 0.07g/L, 0.28 + 0.04g/L control group, no significant difference (t=0.860 P=0.395 P0.05); after first days of treatment group was 0.27 + 0.06g/L, 0.26 + 0.03g/L control group, the difference was not statistically significant (t=0.822 P=0.415 P0.05); after third days, the treatment group is 0.29 + 0.03g/L, 0.27 + 0.05g/L control group, the difference was not statistically significant (t=1.821 P=0.075 P0.05); seventh days after operation. The treatment group was 0.32 + 0.08g/L, 0.28 + 0.04g/L control group, the difference was statistically significant (t=2.120 P=0.039 P0.05); hemoglobin admission: the treatment group was 83.62 + 12.71g/L, 85.67 + 10.52g/L control group, the difference was not statistically significant (t=-0.619 P=0.539P0.05); first days before surgery: treatment group 105.27 + 14.43g/L, 103.79 + 13.75g/L control group, the difference was not statistically significant (t=0.370 P=0.713 P0.05); after first days, the treatment group is 101.08 + 15.55g/L, 98.79 + 14.06g/L control group, the difference was not statistically significant (t=0.544 P=0.589 P0.05); after third days, the treatment group is 112.27 + 11.14g/L, 108.25 in the control group. 13.55g/L, the difference was not statistically significant (t=1.149 P=0.256 P0.05); after seventh days, the treatment group is 120.46 + 10.25g/L, 113.75 + 12.31g/L control group, the difference was statistically significant (t=2.102 P=0.041 P0.05); blood lymphocyte count at the time of admission: the treatment group is 1.51 + 0.18 * 109/L; the control group is 1.62 + 0.19 * 109/L, the difference was not statistically significant (t=-1.955 P=0.056 P0.05); first days before operation: the treatment group is 1.89 + 0.39 * 109/L; the control group is 1.72 + 0.23 * 109/L, the difference was not statistically significant (t=1.953 P=0.057P0.05); after first days, the treatment group is 1.82 + 0.29 * 109/L; control Group 1.70 + 0.22 * 109/L, the difference was not statistically significant (t=1.597 P=0.117 P0.05); after third days, the treatment group is 2.06 + 0.23 * 109/L; the control group is 1.94 + 0.21 * 109/L, the difference was not statistically significant (t=1.944 P=0.058 P0.05); after seventh days of treatment group: 2.38 + 0.16 * 109/L; the control group 2.12 + 0.22 * 109/L, the difference was statistically significant (t=4.845 P=0.000 P0.05); two patients in the postoperative anal exhaust time (d): the treatment group was 2.46 + 0.75D, 3.07 + 1.01d control group (t=-2.443 P=0.018 P0.05); the first defecation time (d): the treatment group was 4.08 + 1.02d, 5.71 in the control group + 1.27d (t=-5.038 P=0.000 P0.05); clearing time (d): the treatment group was 7.70 + 1.44d, the control group was 9 + 1.02d (t=-3.683P=0.001 P0.05); hospitalization time (d): the treatment group was 12.12 + 1.56D, the control group was 16.04 + 1.65d (t=-8.643 P= P0.05 0). The treatment group was shorter in the control group, there was statistically significant difference Two. The incidence of postoperative complications of group: treatment group 3/26 (6% cases): there were no anastomotic fistula and incision infection, 1 cases of incision dehiscence (8.3%), 1 cases of pulmonary infection (8.3%), 1 cases of urinary tract infection (8.3%); the control group consisted of 9/24 cases (18%) the anastomotic fistula in 1 cases (8.3%), incision infection in 1 cases (8.3%), 3 cases of incision dehiscence (25%), 2 cases of pulmonary infection (16.7%), 2 cases of urinary tract infection (16.7%); the incidence rate between the two groups by statistical test, the difference was statistically significant (X2=4.612 P=0.032 P0.05). Conclusion: colorectal cancer patients with peri operative application of intestinal external all-in-one nutrient solution combined with enteral nutrition support treatment in promoting the recovery of gastrointestinal function of patients after surgery, improve the nutritional status, immune function and reduce the incidence of complications has better effect than the control group, contribute to the rapid rehabilitation of patients after surgery.

【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.34

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