论文部分内容阅读
目的:探讨实施早期肠内营养并发胃潴留行规范化处理流程在食管癌患者术后的应用效果，为临床护理提供参考。方法:采用便利抽样，选取2015年7月至2020年6月于大连市第三人民医院胸外科行食管癌切除胃代食管手术后接受早期肠内营养支持治疗中并发胃潴留的84例患者作为研究对象，按入院时间分为对照组和试验组，每组42例，对照组接受常规护理，试验组接受早期肠内营养并发胃潴留规范化处理流程护理。比较2组患者术前和术后7 d营养状况和免疫指标、术后7 d内喂养达标率、术后并发症和肠内营养相关并发症的发生率及住院时间和住院费用的差异。结果:研究过程中对照组失访2例。2组术前营养状况和免疫指标比较差异无统计学意义（n P>0.05）；术后7 d，试验组的体质量指数、血清总蛋白、前白蛋白、氮平衡、IgM、CD3、CD4、CD4/CD8均高于对照组，2组比较差异有统计学意义（n t值为2.228~5.332，n P<0.05或0.01）。试验组7 d内肠内营养喂养达标率为（68.93 ± 8.12）%，对照组为（51.19 ± 6.96）%，2组比较差异有统计学意义（n t值为-4.38，n P<0.01）。试验组术后恶心呕吐、Ⅱ类乙级愈合、吻合口瘘及误吸发生率分别为2.38%（1/42）、2.38%（1/42）、0（0/42）、2.38%（1/42），均低于对照组的15.00%（6/40）、7.50%（3/40）、5.00%（2/40）、10.00%（4/40），差异有统计学意义（n χ2值为5.99~9.88，n P<0.05或0.01）。试验组住院时间为（10.18 ± 1.69）d，住院费用为（53 268.46 ± 3 651.56）元，均低于对照组的（13.66 ± 2.18）d和（64 972.39 ± 4 029.81）元，差异有统计学意义（n t值为2.14、2.89，n P<0.05）。n 结论:实施肠内营养并发胃潴留规范化处理流程能够提高食管癌术后患者7 d内喂养达标率、营养指标和免疫指标，降低术后并发症和肠内营养相关并发症的发生率，减少患者的住院时间，降低住院费用。“,”Objective:To explore the application of standardized treatment process for early enteral nutrition combined with gastric retention after operation in patients with esophageal cancer.Methods:Using convenience sampling, 84 patients with gastric retention complicated by early enteral nutrition support after esophagectomy in Department of Thoracic Surgery, Third People′s Hospital of Dalian from July 2015 to June 2020 were selected as the subjects. They were divided into control group and experimental group according to admission time with 42 cases in each group. The control group received routine nursing, while the experimental group received early enteral nutrition and gastric retention standardized treatment process nursing. The differences between the two groups in nutritional status and immune indexes before and 7 days after operation, the standard feeding rate within 7 days after operation, incidence of postoperative complications and enteral nutrition-related complications, length of hospitalization time and hospitalization expenses were compared.Results:In the control group, 2 cases were lost to follow-up. There was no statistically significant difference in preoperative nutritional status and immune indexes between the two groups (n P<0.05); 7 days after operation, the body mass index, serum total protein, prealbumin, nitrogen balance, IgM, CD3, CD4, and CD4/CD8 of the experimental group were all higher than those of the control group, and the differences between the two groups were statistically significant (n t values were 2.228-5.332, n P<0.05 or 0.01).The standard feeding rate within 7 days was (68.93±8.12)% in the experimental group and (51.19±6.96)% in the control group, respectively, and the difference between the two groups was statistically significant (n t value was -4.38, n P<0.01). The incidence of postoperative nausea and vomiting, Ⅱ B healing, anastomotic fistula and aspiration was 2.38% (1/42), 2.38% (1/42) and 0 (0/42), 2.38% (1/42) in the experimental group and 15.00%(6/40), 7.50% (3/40) and 5.00% (2/40) and 10.00% (4/40) in the control group, respectively, and the differences were statistically significant (n χ2 values were 5.99 - 9.88, n P< 0.05 or 0.01). The length of hospitalization time in the experimental group was (10.18±1.69) d, and the hospitalization cost was (53 268.46 ±3 651.56) yuan, both lower than (13.66 ± 2.18) d and (64 972.39 ± 4 029.81) yuan in the control group, and the difference was statistically significant (n t values were 2.14, 2.89, n P< 0.05).n Conclusions:The standardized treatment process of enteral nutrition combined with gastric retention can improve the feeding rate, nutritional index and immune index within 7 days after operation, reduce postoperative complications and incidence of enteral nutrition related complications, reduce the hospitalization time and reduce hospitalization expenses.