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目的探讨术后不同营养治疗方式对老年胃肠道恶性肿瘤病人的临床疗效。方法胃肠恶性肿瘤术后留观重症监护室病人84例,采用随机数字表法将84例病人分为三种营养治疗方式:全肠外营养治疗组(TPN组)28例,由我院营养科配制营养液,均通过中心静脉导管输注;早期肠内营养治疗组(EEN)组28例,术后用百普素经胃管注入消化道;肠内联合肠外营养治疗组(EN+PN)组28例,术后肠内营养液仍给予百普素,肠外营养仍由我院营养科配制,肠内肠外营养热卡各占1/2。三组病人均术后营养治疗7天,总热卡给予每天25 k Cal/kg。结果 (1)临床情况:EEN、EN+PN组病人肠道通气时间、发热持续时间、住院时间与TPN组比较差异有统计学意义(P<0.05)。EEN组腹泻发生率与TPN、EN+PN组比较差异有统计学意义(P<0.05);(2)营养状态:EEN、TPN、EN+PN组内比较,术后第3天血红蛋白(HGB)、总蛋白(TP)、白蛋白(ALB)与术前比较差异有统计学意义(P<0.05),术后第7天HGB、TP、ALB与术前比较差异无统计学意义(P>0.05),三组组间比较术后第3天与第7天各指标变化均无统计学差异(P>0.05)。(3)肝肾功能:术后第3天和第7天TPN组血丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、γ-谷胺酰转肽酶与EEN、EN+PN组比较差异有统计学意义(P<0.05)。EEN组与EN+PN组肝肾功能变化相当,两组间比较差异无统计学意义(P>0.05)。结论对老年胃肠恶性肿瘤病人术后进行早期EN+PN支持治疗,可减少其术后并发症和住院时间,并且较单纯肠内及全肠外营养治疗效果更优。
Objective To investigate the clinical effects of different nutritional treatments on elderly patients with gastrointestinal cancer. Methods Eighty-four patients with intensive care unit were enrolled in this study. Eighty-four patients were divided into three groups according to random number table: 28 cases of total parenteral nutrition group (TPN group) 28 cases of early enteral nutrition treatment group (EEN) group, with berberine be injected into the digestive tract via gastric tube; enteral parenteral nutrition group (EN + PN) group of 28 cases, after enteral nutrition solution is still given berberine, parenteral nutrition is still prepared by the hospital nutrition, parenteral nutrition heat card each 1/2. Three groups of patients were treated for 7 days postoperative nutrition, the total heat card given daily 25 k Cal / kg. Results (1) Clinical condition: The duration of gut, duration of fever and hospital stay in EEN and EN + PN patients were significantly different from those in TPN group (P <0.05). The incidence of diarrhea in EEN group was significantly lower than that in TPN and EN + PN groups (P <0.05); (2) The nutritional status was significantly higher in EEN, TPN and EN + , Total protein (TP) and albumin (ALB) were significantly different from those before operation (P <0.05). There was no significant difference in HGB, TP, ALB on the 7th day after operation ). There was no significant difference between the three groups on the 3rd and 7th day after operation (P> 0.05). (3) Liver and kidney function: The levels of serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase and EEN in TPN group on the 3rd day and the 7th day after operation, EN + PN group, the difference was statistically significant (P <0.05). The changes of liver and kidney function in EEN group and EN + PN group were similar, with no significant difference between the two groups (P> 0.05). Conclusions Early postoperative EN + PN support for patients with gastrointestinal malignant tumors in the elderly can reduce the postoperative complications and hospital stay, and is more effective than the simple enteral and total parenteral nutrition treatment.