Nursing Department, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
Nutrition. 2022 Feb;94:111540. doi: 10.1016/j.nut.2021.111540. Epub 2021 Nov 15.
Previous studies confirmed the safety and feasibility of oral feeding on the first postoperative day (POD) for patients with minimally invasive esophagectomy (MIE). Nonetheless, some clinical concern can lead to delays in early oral feeding on POD 1. To our knowledge, few reports have focused on resolving these clinical concerns. The aims of this study were to evaluate the effects of an early, quantified, modified oral feeding protocol for patients after MIE and to explore its effect on nutritional status and quality of life (QoL).
In this prospective controlled trail, 200 patients were selected as the intervention group (IG) from March 2020 to June 2021; 115 patients hospitalized from June 2019 to February 2020 were assigned to the control group (CG). For 2 wk during the postoperative period, IG participants received an early, quantified, modified oral feeding protocol. The recovery of dietary outcomes, nutritional status, and QoL were evaluated after the intervention.
There was no significant difference between the two groups in terms of demographic and clinical characteristics and baseline physical function. After the intervention, patients in the IG showed a more rapid growth in daily total oral caloric intake and the ratio of oral calorie intake to total calorie required by the body (K/R value) from POD 1 to POD 14, and less weight loss (1.5 ± 1 versus 2.1 ± 1.7 kg; P < 0.05), better serum prealbumin (193.0 ± 26.9 versus 139.3 ± 27.2 mg/L; P < 0.05) than the CG with statistical significance. By the second week of the intervention, IG patients reported higher global QoL and function scores and lower symptom scores than patients in the CG. The IG participants presented a shorter time to first flatus and bowel movement (P < 0.001), a shorter postoperative hospital length of stay, and higher activities of daily living scores (P < 0.05) the those in the CG.
The findings demonstrated that the early, quantified, modified oral feeding protocol can alleviate postoperative body weight loss, improve the patient's nutritional status, and have a positive effect on QoL and early recovery for patients undergoing MIE.
先前的研究证实了微创食管切除术（MIE）患者术后第一天（POD）经口进食的安全性和可行性。尽管如此，一些临床关注可能导致 POD1 时早期经口进食延迟。据我们所知，很少有研究报告专门解决这些临床问题。本研究旨在评估 MIE 后患者早期、量化、改良口服喂养方案的效果，并探讨其对营养状况和生活质量（QoL）的影响。
在这项前瞻性对照试验中，我们从 2020 年 3 月至 2021 年 6 月选择 200 例患者作为干预组（IG）；将 2019 年 6 月至 2020 年 2 月住院的 115 例患者分为对照组（CG）。在术后 2 周内，IG 患者接受早期、量化、改良的口服喂养方案。干预后评估饮食恢复情况、营养状况和生活质量。
两组患者在人口统计学和临床特征以及基线身体功能方面无显著差异。干预后，IG 患者从 POD1 到 POD14 每日总口服热量摄入和口服热量与机体所需热量的比值（K/R 值）增长更快，体重减轻更少（1.5±1 比 2.1±1.7kg；P<0.05），血清前白蛋白水平更好（193.0±26.9 比 139.3±27.2mg/L；P<0.05）。干预第二周，IG 患者报告的总体生活质量和功能评分更高，症状评分更低，优于 CG 患者。IG 患者首次排气和排便时间（P<0.001）、术后住院时间更短、日常生活活动评分更高（P<0.05）。
研究结果表明，早期、量化、改良的口服喂养方案可以减轻术后体重减轻，改善患者营养状况，对 MIE 患者的生活质量和早期康复产生积极影响。
