Liu Shuo-yan, Chen Xiao-feng, Wang Feng, Zheng Qing-feng, Wang Jian-jian
Department of Thoracic Surgery, Fujian Provincial Tumor Hospital, Fujian Medical University, Fuzhou 350014, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2013 Sep;16(9):864-7.
To compare the efficacy between perioperative enteral and parenteral nutrition support for esophageal cancer patients complicated with diabetes mellitus.
Thirty esophageal cancer patients complicated with diabetes mellitus between September and November 2012 were prospectively enrolled in this trial. According to random number table, 30 cases were randomly divided into enteral group (n=15) and parenteral group (n=15). During the period between 3 days before operation and 8 days after operation, patients received enteral nutrition (AnSure) and parenteral nutrition support respectively. The daily dynamic monitoring of blood glucose was performed. Nutritional indexes (albumin and prealbumin) were evaluated 1-day before operation and 8-day after operation. Postoperative recovery time of gastrointestinal function and complications associated with nutritional support were observed. The cost of nutritional support was calculated.
Patients in the two groups achieved satisfactory perioperative blood glucose control. Finger tip blood glucose was 5.0-9.0 mmol/L before meal, 7.0-10.0 mmol/L 2-hour after meal, and 4.0-8.0 mmol/L at 10 PM and 3 AM. No hypoglycemia (<3.5 mmol/L) was found in all the patients. The time to first flatus after surgery was (62.4±15.7) in the enteral group, significantly earlier than (90.8±22.4) h in the parenteral group (P<0.01). Postoperative nutritional indices and associated complications were not significantly different between two groups (all P>0.05). Cost in the enteral group was significantly lower than that in the parenteral group [(650.8±45.8) RMB vs. (3016.5±152.6) RMB, P<0.01].
Perioperative nutrition support can effectively control blood glucose and improve perioperative nutritional status simultaneously for esophageal cancer patients with diabetes mellitus. Compared with parenteral nutrition, enteral nutrition can accelerate the recovery of gastric bowel function and reduce the cost of nutritional support.
比较围手术期肠内营养与肠外营养支持对合并糖尿病的食管癌患者的疗效。
前瞻性纳入2012年9月至11月间30例合并糖尿病的食管癌患者。根据随机数字表，将30例患者随机分为肠内营养组（n = 15）和肠外营养组（n = 15）。在术前3天至术后8天期间，患者分别接受肠内营养（安素）和肠外营养支持。进行每日血糖动态监测。在术前1天和术后8天评估营养指标（白蛋白和前白蛋白）。观察胃肠功能术后恢复时间及营养支持相关并发症。计算营养支持费用。
两组患者围手术期血糖控制满意。餐前指尖血糖为5.0 - 9.0 mmol/L，餐后2小时为7.0 - 10.0 mmol/L，晚上10点和凌晨3点为4.0 - 8.0 mmol/L。所有患者均未出现低血糖（<3.5 mmol/L）。肠内营养组术后首次排气时间为（62.4±15.7）小时，明显早于肠外营养组的（90.8±22.4）小时（P<0.01）。两组术后营养指标及相关并发症差异无统计学意义（均P>0.05）。肠内营养组费用明显低于肠外营养组[（650.8±45.8）元对（3016.5±152.6）元，P<0.01]。
围手术期营养支持可有效控制合并糖尿病的食管癌患者血糖，同时改善围手术期营养状况。与肠外营养相比，肠内营养可加速胃肠功能恢复并降低营养支持费用。
