本文關(guān)鍵詞： 胃癌 腸內(nèi)營養(yǎng) 短肽　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的:目前,腸內(nèi)營養(yǎng)(enteral nutrition,EN)應(yīng)用于外科術(shù)后病人的作用日益被臨床工作者關(guān)注。據(jù)全國癌癥登記中心顯示,2015年我國胃癌發(fā)病例數(shù)近68萬,僅次于肺癌排名第二位,對于適宜手術(shù)的患者,手術(shù)切除是首選的治療方式。腫瘤自身存在代謝異常,而手術(shù)對機體又是一種打擊,這導(dǎo)致術(shù)后患者的營養(yǎng)狀況往往不理想。我國腸內(nèi)營養(yǎng)制劑分類繁雜,對于不同腸內(nèi)營養(yǎng)劑應(yīng)用與胃癌術(shù)后患者的效果尚缺少橫向比較,本研究旨在對比研究兩種臨床應(yīng)用的腸內(nèi)營養(yǎng)劑(短肽型腸內(nèi)營養(yǎng)劑百普力與整蛋白型腸內(nèi)營養(yǎng)劑能全力)應(yīng)用于胃癌手術(shù)后的臨床療效等有何差異。方法:共納入90例胃癌術(shù)后患者,將納入的患者隨機平分為兩組:短肽型腸內(nèi)營養(yǎng)劑組(短肽組)與整蛋白型腸內(nèi)營養(yǎng)劑組(整蛋白組)。對比研究兩組應(yīng)用不同EN制劑的效果與不良反應(yīng)等有何差異,其中短肽組給予百普力(短肽型腸內(nèi)營養(yǎng)劑),整蛋白組給予能全力(整蛋白型腸內(nèi)營養(yǎng)劑)。于術(shù)前1天、術(shù)后第1天、術(shù)后第8天分別抽取各組患者的外周血,檢測其血液指標,其中包括淋巴細胞計數(shù)(lymphocyte count,LYC)、血紅蛋白(hemoglobin,HGB)、白蛋白(albumin,ALB)、前白蛋白(Prealbumin,PA),并觀察術(shù)后胃腸道功能恢復(fù)時間(排氣時間)、術(shù)后并發(fā)癥(切口感染、肺部感染、吻合口瘺)的發(fā)生率、腸內(nèi)營養(yǎng)支持費用,以及腸內(nèi)營養(yǎng)相關(guān)并發(fā)癥(腹瀉、腹脹、惡心嘔吐)的發(fā)生情況。數(shù)據(jù)的統(tǒng)計分析使用軟件SPSS19.0,以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1.血液指標兩組術(shù)前一天比較三種營養(yǎng)指標ALB、PA、HGB與LYC值無顯著差異(P0.05)。短肽組,術(shù)后第8天與術(shù)后1天相比,ALB、PA、HGB與LYC值明顯上升(P0.05)。整蛋白組,術(shù)后第8天與術(shù)后1天相比,ALB、PA、HGB與LYC值明顯上升(P0.05)。組間對比,術(shù)后第8天短肽組與整蛋白組三種營養(yǎng)指標ALB、PA、HGB與LYC值無統(tǒng)計學(xué)差異(P0.05)。2.腸內(nèi)營養(yǎng)相關(guān)不良反應(yīng):短肽組,發(fā)生腹瀉6例(13.6%),腹脹4例(9.1%),惡心嘔吐3例(6.8%)。整蛋白組,發(fā)生腹瀉14例(31.1%),腹脹13例(28.9%),惡心嘔吐2例(4.4%)。組間相比腹瀉發(fā)生率,短肽組低于整蛋白組(P0.05),其差異具有統(tǒng)計學(xué)意義。腹脹發(fā)生率,短肽組低于整蛋白組(P0.05),其差異具有統(tǒng)計學(xué)意義。其他不良反應(yīng)發(fā)生率無統(tǒng)計學(xué)差異(P0.05)3.術(shù)后并發(fā)癥短肽組,術(shù)后有7例(15.9%)發(fā)生術(shù)后并發(fā)癥;整蛋白組有9例(20%)發(fā)生并發(fā)癥;兩組比較無統(tǒng)計學(xué)差異(P0.05)。4.術(shù)后恢復(fù)排氣時間:短肽組患者恢復(fù)肛門排氣的時間為52.4±6.1h,整蛋白組患者恢復(fù)肛門排氣的時間為52.7±6.4h,組間對比無顯著性差異(P0.05),不具有統(tǒng)計學(xué)意義。5.腸內(nèi)營養(yǎng)支持費用短肽組腸內(nèi)營養(yǎng)支持平均費用為2216±137元,整蛋白組平均費用為1771±111元,組間對比有顯著性差異(P0.05)。結(jié)論：1.短肽型腸內(nèi)營養(yǎng)劑與整蛋白型腸內(nèi)營養(yǎng)劑都可以明顯改善胃癌術(shù)后患者的營養(yǎng)狀態(tài)。2.胃癌術(shù)后早期應(yīng)用短肽型腸內(nèi)營養(yǎng)劑的不良反應(yīng)發(fā)生率要低于整蛋白型腸內(nèi)營養(yǎng)劑。3.短肽型腸內(nèi)營養(yǎng)劑對胃癌術(shù)后患者并發(fā)癥以及胃腸道功能恢復(fù)的時間影響較之與整蛋白型腸內(nèi)營養(yǎng)劑并無差異,從經(jīng)濟學(xué)的角度出發(fā),考慮到短肽型腸內(nèi)營養(yǎng)劑的支持費用明顯高于整蛋白型腸內(nèi)營養(yǎng)劑,對于胃癌術(shù)后患者可先用短肽型腸內(nèi)營養(yǎng)劑,待患者恢復(fù)排氣后逐漸改為整蛋白型腸內(nèi)營養(yǎng)劑。
[Abstract]:Background and objective: at present, enteral nutrition (enteral, nutrition, EN) applied to the patients after surgery effect has been clinical workers attention. According to the National Cancer Registration Center shows that in 2015 China's nearly 680 thousand cases of gastric cancer, lung cancer ranked second, suitable for surgery, surgical resection is preferred treatment of tumor. Their metabolic abnormalities, and surgery on the body is a blow, which leads to postoperative nutritional status of patients is not ideal in China. Enteral nutrition for patients with complex classification, the effect of different enteral nutrition of patients with gastric carcinoma is still a lack of horizontal comparison, this study is to compare the research two kinds of clinical application of enteral nutrition (Short Peptide Enteral Nutrition Powder and Intacted Protein Enteral Nutrition Powder to Peptison) what is the difference in gastric cancer after surgery clinical curative effect. Methods: a total of 90 cases In patients with gastric cancer after operation, the patients were randomly divided into two groups: Short Peptide Enteral Nutrition Powder group (short peptide group) and Intacted Protein Enteral Nutrition Powder group (whole protein group). Comparison of two groups with different formulations of EN effect and adverse reaction of the difference in the peptide group was given Peptison (Short Peptide Enteral Nutrition Powder), the whole protein group to give (Intacted Protein Enteral Nutrition Powder). On the 1 day before surgery, after first days, eighth days after surgery respectively. Peripheral blood samples were collected from each group of patients, the detection of blood parameters, including lymphocyte count (lymphocyte, count, LYC), hemoglobin (hemoglobin, HGB), albumin (albumin, ALB), prealbumin (Prealbumin, PA), and observe the time of postoperative recovery of gastrointestinal function (exhaust), postoperative complications (wound infection, pulmonary infection, anastomotic fistula) the incidence of enteral nutrition and enteral nutrition related costs, and 鍙戠棁(鑵規(guī)郴,鑵硅儉,鎭跺績鍛曞悙)鐨勫彂鐢熸儏鍐，

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