本文關(guān)鍵詞：結(jié)直腸癌患者圍術(shù)期營(yíng)養(yǎng)支持治療的臨床療效研究　出處：《廣西中醫(yī)藥大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 結(jié)直腸癌 圍術(shù)期 營(yíng)養(yǎng)支持 腸內(nèi)營(yíng)養(yǎng) 腸外營(yíng)養(yǎng)

【摘要】：目的:比較結(jié)直腸癌患者圍術(shù)期應(yīng)用腸外全合一營(yíng)養(yǎng)液聯(lián)合腸內(nèi)營(yíng)養(yǎng)支持治療與單瓶滴注腸外營(yíng)養(yǎng)液制劑聯(lián)合腸內(nèi)營(yíng)養(yǎng)支持治療的臨床療效及其優(yōu)勢(shì)。方法:本研究收集了廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院自2014年1月至2016年1月擬實(shí)施外科手術(shù)治療的結(jié)直腸癌患者臨床病例資料共52例,隨機(jī)分為腸外全合一營(yíng)養(yǎng)液聯(lián)合腸內(nèi)營(yíng)養(yǎng)支持治療26例和單瓶滴注腸外營(yíng)養(yǎng)液制劑聯(lián)合腸內(nèi)營(yíng)養(yǎng)支持治療26例。觀察應(yīng)用兩種營(yíng)養(yǎng)支持治療方式后患者圍術(shù)期的各項(xiàng)實(shí)驗(yàn)室及臨床指標(biāo)和術(shù)后并發(fā)癥發(fā)生率。結(jié)果:除對(duì)照組2例患者終止試驗(yàn)外,其余均按計(jì)劃完成。兩組患者的臨床一般資料和疾病資料的基線基本一致,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。兩組患者入院時(shí)血清白蛋白、血清前白蛋白、血紅蛋白、總淋巴細(xì)胞計(jì)數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性(P0.05)。血清白蛋白入院時(shí):治療組為24.73±2.93g/L,對(duì)照組25.70±4.24g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.941 P=0.352 P0.05);術(shù)前第1天:治療組為31.15±3.16g/L,對(duì)照組30.17±4.51g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.356 P=0.371P0.05);術(shù)后第1天:治療組為30.23±4.15g/L,對(duì)照組28.96±2.77g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.266 P=0.212 P0.05);術(shù)后第3天:治療組為34.15±5.61g/L,對(duì)照組31.33±6.65g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.625P=0.111 P0.05);術(shù)后第7天:治療組為39.42±4.20g/L,對(duì)照組36.79±3.78g/L,差異有統(tǒng)計(jì)學(xué)意義(t=2.324 P=0.024 P0.05);血清前白蛋白入院時(shí):治療組為0.15±0.03g/L;對(duì)照組0.16±0.02g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.623 P=0.111 P0.05);術(shù)前第1天:治療組為0.29±0.07g/L,對(duì)照組0.28±0.04g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.860 P=0.395 P0.05);術(shù)后第1天:治療組為0.27±0.06g/L,對(duì)照組0.26±0.03g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.822 P=0.415 P0.05);術(shù)后第3天:治療組為0.29±0.03g/L,對(duì)照組0.27±0.05g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.821 P=0.075 P0.05);術(shù)后第7天:治療組為0.32±0.08g/L,對(duì)照組0.28±0.04g/L,差異有統(tǒng)計(jì)學(xué)意義(t=2.120 P=0.039 P0.05);血紅蛋白入院時(shí):治療組為83.62±12.71g/L,對(duì)照組85.67±10.52g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.619 P=0.539P0.05);術(shù)前第1天:治療組為105.27±14.43g/L,對(duì)照組103.79±13.75g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.370 P=0.713 P0.05);術(shù)后第1天:治療組為101.08±15.55g/L,對(duì)照組98.79±14.06g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.544 P=0.589 P0.05);術(shù)后第3天:治療組為112.27±11.14g/L,對(duì)照組108.25±13.55g/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.149 P=0.256 P0.05);術(shù)后第7天:治療組為120.46±10.25g/L,對(duì)照組113.75±12.31g/L,差異有統(tǒng)計(jì)學(xué)意義(t=2.102 P=0.041 P0.05);血總淋巴細(xì)胞計(jì)數(shù)入院時(shí):治療組為1.51±0.18×109/L;對(duì)照組1.62±0.19×109/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-1.955 P=0.056 P0.05);術(shù)前第1天:治療組為1.89±0.39×109/L;對(duì)照組1.72±0.23×109/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.953 P=0.057P0.05);術(shù)后第1天:治療組為1.82±0.29×109/L;對(duì)照組1.70±0.22×109/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.597 P=0.117 P0.05);術(shù)后第3天:治療組為2.06±0.23×109/L;對(duì)照組1.94±0.21×109/L,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.944 P=0.058 P0.05);術(shù)后第7天:治療組2.38±0.16×109/L;對(duì)照組2.12±0.22×109/L,差異有統(tǒng)計(jì)學(xué)意義(t=4.845 P=0.000 P0.05);兩組患者在術(shù)后首次肛門(mén)排氣時(shí)間(d):治療組為2.46±0.75d,對(duì)照組3.07±1.01d(t=-2.443 P=0.018 P0.05);首次排便時(shí)間(d):治療組4.08±1.02d,對(duì)照組5.71±1.27d(t=-5.038 P=0.000 P0.05);拆線時(shí)間(d):治療組為7.70±1.44d,對(duì)照組為9.00±1.02d(t=-3.683P=0.001 P0.05);住院時(shí)間(d):治療組為12.12±1.56d,對(duì)照組為16.04±1.65d(t=-8.643 P=0.000 P0.05)。治療組的時(shí)間明顯短于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義。兩組術(shù)后并發(fā)癥發(fā)生率:治療組共有3/26例(6.0%):其中未出現(xiàn)吻合口瘺及切口感染,切口裂開(kāi)1例(8.3%)、肺部感染1例(8.3%)、泌尿系感染1例(8.3%);對(duì)照組共有9/24例(18.0%):吻合口瘺1例(8.3%)、切口感染1例(8.3%)、切口裂開(kāi)3例(25.0%)、肺部感染2例(16.7%)、泌尿系感染2例(16.7%);兩組間發(fā)生率經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(X2=4.612 P=0.032 P0.05)。結(jié)論:結(jié)直腸癌患者圍術(shù)期應(yīng)用腸外全合一營(yíng)養(yǎng)液聯(lián)合腸內(nèi)營(yíng)養(yǎng)支持治療在促進(jìn)患者術(shù)后胃腸功能恢復(fù),改善營(yíng)養(yǎng)狀況、免疫功能及降低并發(fā)癥發(fā)生率方面療效優(yōu)于對(duì)照組,對(duì)患者術(shù)后的快速康復(fù)有促進(jìn)作用。
[Abstract]:Objective: To compare the results of perioperative application of intestinal cancer patients outside the all-in-one nutrient solution combined with enteral nutrition and intestinal therapy and single bottle infusion of parenteral nutrition formulations of nutrition in clinical efficacy and advantages of treatment. Methods: This study collected Rui Kang Hospital of Guangxi traditional Chinese Medical University from January 2014 to January 2016 to be the clinical data of patients with colorectal cancer surgery for a total of 52 patients were randomly divided into a total parenteral nutrient solution combined with enteral nutrition in the treatment of 26 cases of single bottle infusion and parenteral nutrition combined with enteral nutrition preparation in treatment of 26 cases. Observe the application of two kinds of nutritional support treatment after surgery the laboratory and clinical indicators and the incidence of postoperative complications. Results: in addition to the control group of 2 patients with the end of the experiment, the rest were completed according to plan. The general information and clinical data of two patients of the disease group The line is basically the same, the difference was not statistically significant (P0.05), comparable. Two serum albumin, serum albumin, hemoglobin, total lymphocyte count had no significant difference, comparable. Serum albumin (P0.05) at the time of admission: the treatment group was 24.73 + 2.93g/L, 25.70 + 4.24g/L control group, the difference was not statistically significant (t=-0.941 P=0.352 P0.05); first days before operation: the treatment group was 31.15 + 3.16g/L, 30.17 + 4.51g/L control group, the difference was not statistically significant (t=0.356 P=0.371P0.05); after first days, the treatment group is 30.23 + 4.15g/L, 28.96 + 2.77g/L control group, the difference was not statistically significant (t=1.266 P=0.212, P0.05); after third days of treatment group was 34.15 + 5.61g/L, 31.33 + 6.65g/L control group, the difference was not statistically significant (t=1.625P=0.111 P0.05); after seventh days, the treatment group is 39.42 + 4.20g/L, 36.79 + 3.78g/L control group, the difference was statistically Meaning (t=2.324 P=0.024 P0.05); serum prealbumin admission: the treatment group was 0.15 + 0.03g/L 0.16 + 0.02g/L; the control group, the difference was not statistically significant (t=-1.623 P=0.111 P0.05); first days before operation: the treatment group was 0.29 + 0.07g/L, 0.28 + 0.04g/L control group, no significant difference (t=0.860 P=0.395 P0.05); after first days of treatment group was 0.27 + 0.06g/L, 0.26 + 0.03g/L control group, the difference was not statistically significant (t=0.822 P=0.415 P0.05); after third days, the treatment group is 0.29 + 0.03g/L, 0.27 + 0.05g/L control group, the difference was not statistically significant (t=1.821 P=0.075 P0.05); seventh days after operation. The treatment group was 0.32 + 0.08g/L, 0.28 + 0.04g/L control group, the difference was statistically significant (t=2.120 P=0.039 P0.05); hemoglobin admission: the treatment group was 83.62 + 12.71g/L, 85.67 + 10.52g/L control group, the difference was not statistically significant (t=-0.619 P=0.539P0.05); first days before surgery: treatment group 105.27 + 14.43g/L, 103.79 + 13.75g/L control group, the difference was not statistically significant (t=0.370 P=0.713 P0.05); after first days, the treatment group is 101.08 + 15.55g/L, 98.79 + 14.06g/L control group, the difference was not statistically significant (t=0.544 P=0.589 P0.05); after third days, the treatment group is 112.27 + 11.14g/L, 108.25 in the control group. 13.55g/L, the difference was not statistically significant (t=1.149 P=0.256 P0.05); after seventh days, the treatment group is 120.46 + 10.25g/L, 113.75 + 12.31g/L control group, the difference was statistically significant (t=2.102 P=0.041 P0.05); blood lymphocyte count at the time of admission: the treatment group is 1.51 + 0.18 * 109/L; the control group is 1.62 + 0.19 * 109/L, the difference was not statistically significant (t=-1.955 P=0.056 P0.05); first days before operation: the treatment group is 1.89 + 0.39 * 109/L; the control group is 1.72 + 0.23 * 109/L, the difference was not statistically significant (t=1.953 P=0.057P0.05); after first days, the treatment group is 1.82 + 0.29 * 109/L; control Group 1.70 + 0.22 * 109/L, the difference was not statistically significant (t=1.597 P=0.117 P0.05); after third days, the treatment group is 2.06 + 0.23 * 109/L; the control group is 1.94 + 0.21 * 109/L, the difference was not statistically significant (t=1.944 P=0.058 P0.05); after seventh days of treatment group: 2.38 + 0.16 * 109/L; the control group 2.12 + 0.22 * 109/L, the difference was statistically significant (t=4.845 P=0.000 P0.05); two patients in the postoperative anal exhaust time (d): the treatment group was 2.46 + 0.75D, 3.07 + 1.01d control group (t=-2.443 P=0.018 P0.05); the first defecation time (d): the treatment group was 4.08 + 1.02d, 5.71 in the control group + 1.27d (t=-5.038 P=0.000 P0.05); clearing time (d): the treatment group was 7.70 + 1.44d, the control group was 9 + 1.02d (t=-3.683P=0.001 P0.05); hospitalization time (d): the treatment group was 12.12 + 1.56D, the control group was 16.04 + 1.65d (t=-8.643 P= P0.05 0). The treatment group was shorter in the control group, there was statistically significant difference Two. The incidence of postoperative complications of group: treatment group 3/26 (6% cases): there were no anastomotic fistula and incision infection, 1 cases of incision dehiscence (8.3%), 1 cases of pulmonary infection (8.3%), 1 cases of urinary tract infection (8.3%); the control group consisted of 9/24 cases (18%) the anastomotic fistula in 1 cases (8.3%), incision infection in 1 cases (8.3%), 3 cases of incision dehiscence (25%), 2 cases of pulmonary infection (16.7%), 2 cases of urinary tract infection (16.7%); the incidence rate between the two groups by statistical test, the difference was statistically significant (X2=4.612 P=0.032 P0.05). Conclusion: colorectal cancer patients with peri operative application of intestinal external all-in-one nutrient solution combined with enteral nutrition support treatment in promoting the recovery of gastrointestinal function of patients after surgery, improve the nutritional status, immune function and reduce the incidence of complications has better effect than the control group, contribute to the rapid rehabilitation of patients after surgery.

【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R735.34

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7 王海桃;;危重癥與營(yíng)養(yǎng)支持[A];第8屆全國(guó)重癥監(jiān)護(hù)專(zhuān)科護(hù)理新進(jìn)展研討會(huì)論文匯編[C];2011年

8 劉朋;;營(yíng)養(yǎng)支持在常見(jiàn)疾病中的合理使用[A];2012年全國(guó)醫(yī)院藥物治療風(fēng)險(xiǎn)管理學(xué)術(shù)研討會(huì)會(huì)議資料[C];2012年

9 張片紅;;家庭營(yíng)養(yǎng)支持的應(yīng)用[A];2012年浙江省腸外腸內(nèi)營(yíng)養(yǎng)學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

10 鄭培奮;;醫(yī)務(wù)人員營(yíng)養(yǎng)認(rèn)知與營(yíng)養(yǎng)支持及結(jié)局[A];2013年浙江省腸外腸內(nèi)營(yíng)養(yǎng)學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2013年

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2 龔怡;惡性腫瘤的營(yíng)養(yǎng)支持治療[N];中國(guó)醫(yī)藥報(bào);2004年

3 整理 施敏;營(yíng)養(yǎng)支持 有規(guī)范不逾矩[N];健康報(bào);2011年

4 本報(bào)記者 陳e，

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