Department of Gastrointestinal Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006 Hangzhou, China.
Comput Math Methods Med. 2022 Jun 29;2022:4977922. doi: 10.1155/2022/4977922. eCollection 2022.
This study explored the effect of different nutritional nursing support on nutritional status, immune function, postoperative bowel motility, and complications in elderly patients with gastrointestinal tumors during the perioperative period.
300 patients with gastrointestinal tumors treated in the Department of Gastroenterology and anorectal surgery of Hangzhou First People's Hospital Affiliated with the Medical College of Zhejiang University from February 2018 to March 2020 were selected as the research objects in this study. Patients were divided into the early enteral nutrition (EEN) and total parenteral nutrition (TPN) groups (150 cases in each group) according to the principle of odd and even admission numbers. The patients in the EEN and TPN groups were given enteral nutrition nursing support and parenteral nutrition nursing support, respectively. The nutritional status, immune function, postoperative bowel motility, and complication rate of the two groups were evaluated 7 days after the operation.
The nutritional indexes decreased 3 days after the operation and gradually recovered 7 days after the operation in both groups with different nutritional nursing support. The Hb, TRF, PAB, and ALB indexes in the TPN group were significantly lower than those in the EEN group ( < 0.01). On the 7th day after the operation, the indexes of peripheral blood immunoglobulin (IgG, IgM, and IgA) were significantly lower than those in the TPN group, and T lymphocyte subsets (CD4, CD8, and CD4/CD8) demonstrated that the immunological indexes of patients in the EEN group were significantly higher than those in the TPN group ( < 0.01). In terms of intestinal peristalsis, the time of first exhaust and first defecation in the EEN group was significantly shorter than that in the TPN group ( < 0.01) during the perioperative period. Furthermore, both groups had different degrees of complications, while patients demonstrated a lower complication rate in the EEN group compared to those in the TPN group, suggesting a safer postoperative mode. The results of subgroup analysis showed that the nutritional indexes of the gastric cancer group 7 days after operation were significantly higher than those of the colorectal cancer group under EEN and TPN nutritional support modes.
Clinical results have suggested that enteral nutrition nursing support can improve the perioperative nutritional status of elderly patients with gastrointestinal tumors by enhancing the immune function and promoting intestinal peristalsis. Meanwhile, the postoperative EEN mode reduces the rate of complications and demonstrates higher safety. Therefore, it has a high clinical application value.
本研究旨在探讨不同营养护理支持对老年胃肠肿瘤患者围手术期营养状况、免疫功能、术后肠道动力及并发症的影响。
选取 2018 年 2 月至 2020 年 3 月在浙江大学医学院附属杭州市第一人民医院胃肠肛肠外科治疗的 300 例胃肠肿瘤患者作为研究对象。根据入院单双号原则将患者分为早期肠内营养（EEN）组和全肠外营养（TPN）组，每组 150 例。EEN 组和 TPN 组分别给予肠内营养护理支持和肠外营养护理支持，评价两组患者术后 7 天的营养状况、免疫功能、术后肠道动力及并发症发生率。
两组患者在接受不同营养护理支持后，术后 3 天营养指标下降，术后 7 天逐渐恢复，TPN 组患者的 Hb、TRF、PAB 和 ALB 指标明显低于 EEN 组（<0.01）。术后第 7 天，外周血免疫球蛋白（IgG、IgM 和 IgA）指标明显低于 TPN 组，T 淋巴细胞亚群（CD4、CD8 和 CD4/CD8）提示 EEN 组患者的免疫指标明显高于 TPN 组（<0.01）。在肠道蠕动方面，EEN 组患者的首次排气和首次排便时间明显短于 TPN 组（<0.01）。此外，两组患者均有不同程度的并发症，EEN 组患者的并发症发生率明显低于 TPN 组，提示术后模式更安全。亚组分析结果表明，EEN 和 TPN 营养支持模式下，胃癌组患者术后 7 天的营养指标明显高于结直肠癌组。
临床结果表明，肠内营养护理支持可通过增强免疫功能和促进肠道蠕动来改善老年胃肠肿瘤患者的围手术期营养状况。同时，术后 EEN 模式降低了并发症发生率，安全性更高，具有较高的临床应用价值。
