作者：陈钦1，孙卫江1，李松端2，佘佩吟1，谢昭雄1

单位：1.广东省潮州市中心医院 普外二科，广东 潮州 521000； 2.广东省潮州市中心医院 麻醉科，广东 潮州 521000

Authors:  CHEN Qin1, SUN Weijiang1, LI Songrui2, SHE Peiyin1, XIE Zhaoxiong1

Unit:  1.2nd Department of General Surgery, Central Hospital of Chaozhou, Chaozhou 521000, Guangdong, China;  2.Department of Anesthesia, Central Hospital of Chaozhou, Chaozhou 521000, Guangdong, China

摘要：

目的  通过对胃肠肿瘤围手术期营养代谢变化观察,围手术期营养风险评估,应激状态评估,胃肠功能状态评估,制定肠外、肠内营养治疗策略。方法  1、将胃肠肿瘤患者随机分成实验组(营养干预策略组)和对照组(经验性营养治疗组:无应激状态评估,无胃肠功能评估,实施营养治疗,治疗途径随意性)各30例患者,对比两组手术前手术后营养代谢指标变化。2、排除条件:无法行择期手术者,基础疾病严重者。结果  1、实验组及对照组手术前后一周代谢生化指标存在差异性:手术前后白蛋白降低、淋巴细胞水平明显降低,空腹血糖、CRP、PCT、甘油三酯值水平明显升高;2、(1)手术前后一周代谢生化指标实验组优于对照组;(2)术后24-48小时应激指标及48-72小时进展加重性应激指标实验组优于对照组;(3)恢复正氮平衡所需时间实验组优于对照组;(4)营养状况体质指数改变情况、感染并发症发生率、住院时间、住院费用等实验组优于对照组。结论  围手术期营养治疗策略可在术后早期提高患者的免疫功能,减轻术后应激反应,降低术后并发症的发生率,并缩短平均住院时间。

关键词： 营养治疗; 胃肠肿瘤; 围手术期; 预后

Abstract：

Objective  During perioperative management of gastrointestinal tumor, to formulate the parenteral and enteral nutrition treatment strategy by observing the nutrition metabolic changes, perioperative nutrition risk assessment, stress state assessment, and gastrointestinal function state assessment. Methods  The patients with gastrointestinal tumor were randomly divided into nutrition group and control group, with 30 patients in each group. The changes of nutritional metabolism indexes after operation were compared between two groups. Results  Metabolic biochemical indexes before and after one week post-operation were markedly different between the nutrition and control groups, with increased albumin and lymphocyte levels, decreased fasting blood glucose, CRP, PCT and triglyceride levels observed. The stress indexes at 24-48 hours and the progressive stress indexes at 48-72 hours after operation were better in nutrition group than those in control group. The time needed for recovering positive nitrogen balance was improved. Besides, the changes of nutritional status, the incidence of infection complications, the length of stay (LOS) and expense were also improved. Conclusions  Perioperative nutrition therapy could improve the immune function of patients at the early stage, reduce the postoperative stress reaction, decrease the incidence of postoperative complications, and shorten the LOS for such patients.

Key Words:  Nutrition therapy; Gastrointestinal neoplasm; Perioperative period; Prognosis