经鼻胃管肠内营养在胃癌加速康复外科中的应用研究

发布时间：2021-03-08 12:36

　　背景:ERAS（加速康复）是促进患者早期恢复的一种多模式方法,通过对ERAS与常规方法的比较研究,认为ERAS优于常规方法,因此,ERAS方案被广泛推荐。尽管ERAS被广泛接受,但是其中的一些原则依然很难遵守。然而,研究表明,营养和早期经口饮食等具体途径具有挑战性,值得注意的是,有研究表明,营养不良与手术压力增加两者之间有联系。此外,胃切除术后营养不良的患者往往会导致术后并发症,这是由于先天免疫减弱、炎症反应、术后肠梗阻持续时间较长所致,肠道通透性、虚弱、血糖水平不稳定和更多的营养并发症导致术后预后不良。患者在术后1-3天经口给予流质饮食。这可能不能够提供足够的营养来促进机体免疫系统,同时也不能为胃癌患者提供足够的能量,以实现加速康复的目标。值得注意的是,由于ERAS指南建议取消EN（肠内营养）进食,因此尚无关于通过肠内营养治疗胃癌的ERAS患者的数据。目的:当前的研究旨在分析来自几项观察性队列研究的可用证据,然后进行一项回顾性研究,以对饲管的重要性及其在ERAS指导下的益处进行回顾性研究。方法:所有分析均由Review Manager（Rev-Man）5.3、（SPSS）22版或（S... 

【文章来源】：江苏大学江苏省

【文章页数】：80 页

【学位级别】：硕士

【文章目录】：
ABSTRACT
摘要
CHAPTER1:INTRODUCTION
    1.1 CURRENT AND FUTURE IMPLEMENTATION OF ERAS PATHWAYS
    1.2 PRE-OPERATIVE PERIOD
        1.2.1 Information
        1.2.2 Optimization
        1.2.3 Physiotherapy
        1.2.4 Nutrition support
        1.2.5 Mechanical bowel preparation
        1.2.6 Fasting
        1.2.7 Opioid sparing
    1.3 OPERATIVE PERIOD
        1.3.1 Prophylactics
        1.3.2 Anaesthesia
        1.3.3 Surgical stress
        1.3.4 Fluid therapy
        1.3.5 Prophylactic feeding tubes
    1.4 POSTOPERATIVE PERIOD
        1.4.1 PONV
        1.4.2 Early oral feeding
        1.4.3 Balanced analgesia
        1.4.4 Early mobilization
    1.5 FEASIBILITY AND BENEFITS OF ERAS PATHWAYS
    1.6 CHALLENGES ARGUMENTS AND IMPROVEMENTS
    1.7 FUTURE DIRECTIONS
    1.8 SUMMARY
CHAPTER2:SHORT-TERM EVALUATION OF IMMUNE LEVELS AND NUTRITIONAL VALUES OF EN VERSUS PN IN GASTRIC CANCER:A SYSTEMATIC REVIEW AND A META-ANALYSIS
    2.1 BACKGROUND
    2.2 METHODS
        2.2.1 Retrieval strategy
        2.2.2 Inclusion and exclusion criteria
    2.3 STATISTICAL ANALYSIS
    2.4 RESULTS
        2.4.1 General characteristics
        2.4.2 Analysis of immune indicators
        2.4.3 Analysis of Nutrition indices
        2.4.4 Analysis of postoperative clinical outcomes
    2.5 ASSESSMENT OF PUBLICATION BIAS
    2.6 DISCUSSION
    2.7 CONCLUSIONS
    2.8 FUTURE DIRECTIONS
CHAPTER3:RETROSPECTIVE STUDY ON CLINICAL OUTCOMES OF GASTRIC CANCER PATIENTS UNDER MODIFIED NUTRITION IN ERAS
    3.1 BACKGROUND
    3.2 MATERIALS,METHODS AND ANALYSIS
        3.2.1 Enteral nutrition suspension and tube
        3.2.2 Inclusion and exclusion criteria
        3.2.3 Statistical analysis
    3.3 RESULTS
        3.3.1 Clinical indices
    3.4 DISCUSSION
CHAPTER4:GENERAL CONCLUSION AND RECOMMENDATIONS
    4.1 GENERAL CONCLUSION
    4.2 RECOMMENDATIONS
REFERENCES
LIST OF ABBREVIATIONS
LISTS OF PUBLICATIONS
ACKNOWLEDGEMENT
Study limitations
Ethics


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期刊论文
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