Hartsell P A, Frazee R C, Harrison J B, Smith R W
Department of Surgery, Scott & White Clinic and Memorial Hospital, Temple, USA.
Arch Surg. 1997 May;132(5):518-20; discussion 520-1. doi: 10.1001/archsurg.1997.01430290064011.
Several investigators have demonstrated that routine nasogastric decompression after abdominal surgery is unnecessary and can be safely eliminated, and 1 recent study demonstrated the safety of early oral feedings.
To test the hypothesis that successful early feeding would lead to a shorter duration of hospitalization and, therefore, would be more cost-effective.
Fifty-eight patients with elective colorectal surgery.
Patients were prospectively randomized to 1 of 2 postoperative treatment arms: early feeding (EF group, n = 29) and traditional feeding (TF group, n = 29). All patients in the EF group began a liquid diet on the first postoperative day and were advanced to a regular diet when they consumed 1000 mL in 24 hours. All patients in the TF group began a liquid diet after resolution of the postoperative ileus and were advanced to a regular diet after consuming 1000 mL in 24 hours. Patients were dismissed after tolerating two thirds of the regular diet. Both groups had intraoperative orogastric tubes that were removed at the end of surgery. Nasogastric tubes were inserted for persistent postoperative vomiting.
No significant differences were noted in age, types of procedures, or in prior abdominal surgery in either group. No significant differences were seen in rates of nausea (55% in EF vs 50% in TF group) or vomiting (48% in EF vs 33% in TF group). One patient in the EF group had aspiration pneumonia, and anastomotic leak resulted in sepsis and eventual death of 1 patient in the TF group. No significant difference was observed in length of hospital stay between the 2 groups (mean +/- SD, 7.2 +/- 3.3 days in EF vs 8.1 +/- 2.3 days in TF group).
Early oral feeding after elective colorectal surgery is safe. Most of the patients tolerated EF; however, there was no significant difference in duration of hospitalization in these patients.
多项研究表明，腹部手术后常规的鼻胃管减压并无必要，可安全取消，且近期一项研究证明了早期经口进食的安全性。
验证早期成功进食可缩短住院时间，进而提高成本效益这一假设。
58例择期结直肠手术患者。
患者前瞻性随机分为2个术后治疗组之一：早期进食组（EF组，n = 29）和传统进食组（TF组，n = 29）。EF组所有患者术后第1天开始流食，当24小时内摄入1000 mL时改为常规饮食。TF组所有患者术后肠梗阻缓解后开始流食，24小时内摄入1000 mL后改为常规饮食。患者耐受三分之二常规饮食后出院。两组患者术中均留置口胃管，手术结束时拔除。术后持续呕吐则插入鼻胃管。
两组患者在年龄、手术类型或既往腹部手术方面均无显著差异。恶心发生率（EF组55%，TF组50%）或呕吐发生率（EF组48%，TF组33%）无显著差异。EF组1例患者发生吸入性肺炎，TF组1例患者因吻合口漏导致败血症并最终死亡。两组患者住院时间无显著差异（平均值±标准差，EF组为7.2±3.3天，TF组为8.1±2.3天）。
择期结直肠手术后早期经口进食是安全的。大多数患者耐受早期进食；然而，这些患者的住院时间并无显著差异。
