Chen Zhi-Hua, Lin Su-Yong, Dai Qi-Bao, Hua Jin, Chen Shao-Qin
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.
Nutrients. 2017 Apr 10;9(4):373. doi: 10.3390/nu9040373.
We examined gastric outlet obstruction (GOO) patients who received two weeks of strengthening pre-operative enteral nutrition therapy (pre-EN) through a nasal-jejenal feeding tube placed under a gastroscope to evaluate the feasibility and potential benefit of pre-EN compared to parenteral nutrition (PN). In this study, 68 patients confirmed to have GOO with upper-gastrointestinal contrast and who accepted the operation were randomized into an EN group and a PN group. The differences in nutritional status, immune function, post-operative complications, weight of patients, first bowel sound and first flatus time, pull tube time, length of hospital stay (LOH), and cost of hospitalization between pre-operation and post-operation were all recorded. Statistical analyses were performed using the chi square test and -test; statistical significance was defined as < 0.05. The success rate of the placement was 91.18% (three out of 31 cases). After pre-EN, the levels of weight, albumin (ALB), prealbumin (PA), and transferrin (TNF) in the EN group were significantly increased by pre-operation day compared to admission day, but were not significantly increased in the PN group; the weights in the EN group were significantly increased compared to the PN group by pre-operation day and day of discharge; total protein (TP), ALB, PA, and TNF of the EN group were significantly increased compared to the PN group on pre-operation and post-operative days one and three. The levels of CD3+, CD4+/CD8+, IgA, and IgM in the EN group were higher than those of the PN group at pre-operation and post-operation; the EN group had a significantly lower incidence of poor wound healing, peritoneal cavity infection, pneumonia, and a shorter first bowel sound time, first flatus time, and post-operation hospital stay than the PN group. Pre-EN through a nasal-jejunum feeding tube and placed under a gastroscope in GOO patients was safe, feasible, and beneficial to the nutrition status, immune function, and gastrointestinal function, and sped up recovery, while not increasing the cost of hospitalization.
我们对接受了为期两周强化术前肠内营养治疗(术前肠内营养)的胃出口梗阻(GOO)患者进行了研究,这些患者通过在胃镜引导下放置的鼻空肠喂养管接受治疗,以评估术前肠内营养与肠外营养(PN)相比的可行性和潜在益处。在本研究中,68例经上消化道造影确诊为GOO且接受手术的患者被随机分为肠内营养组和肠外营养组。记录术前和术后患者的营养状况、免疫功能、术后并发症、体重、首次肠鸣音和首次排气时间、拔管时间、住院时间(LOH)以及住院费用的差异。采用卡方检验和t检验进行统计分析;统计学显著性定义为P<0.05。置管成功率为91.18%(31例中有3例)。术前肠内营养后,与入院日相比,肠内营养组术前体重、白蛋白(ALB)、前白蛋白(PA)和转铁蛋白(TNF)水平显著升高,但肠外营养组无显著升高;与肠外营养组相比,肠内营养组术前和出院日体重显著增加;术前及术后第1天和第3天,肠内营养组的总蛋白(TP)、ALB、PA和TNF水平均显著高于肠外营养组。术前和术后肠内营养组的CD3+、CD4+/CD8+、IgA和IgM水平均高于肠外营养组;与肠外营养组相比,肠内营养组伤口愈合不良、腹腔感染、肺炎的发生率显著降低,首次肠鸣音时间、首次排气时间和术后住院时间显著缩短。在GOO患者中,通过胃镜引导下放置鼻空肠喂养管进行术前肠内营养是安全、可行的,对营养状况、免疫功能和胃肠功能有益,可加速康复,且不增加住院费用。