背景:ERAS（加速康復）是促進患者早期恢復的一種多模式方法,通過對ERAS與常規(guī)方法的比較研究,認為ERAS優(yōu)于常規(guī)方法,因此,ERAS方案被廣泛推薦。盡管ERAS被廣泛接受,但是其中的一些原則依然很難遵守。然而,研究表明,營養(yǎng)和早期經口飲食等具體途徑具有挑戰(zhàn)性,值得注意的是,有研究表明,營養(yǎng)不良與手術壓力增加兩者之間有聯(lián)系。此外,胃切除術后營養(yǎng)不良的患者往往會導致術后并發(fā)癥,這是由于先天免疫減弱、炎癥反應、術后腸梗阻持續(xù)時間較長所致,腸道通透性、虛弱、血糖水平不穩(wěn)定和更多的營養(yǎng)并發(fā)癥導致術后預后不良。患者在術后1-3天經口給予流質飲食。這可能不能夠提供足夠的營養(yǎng)來促進機體免疫系統(tǒng),同時也不能為胃癌患者提供足夠的能量,以實現加速康復的目標。值得注意的是,由于ERAS指南建議取消EN（腸內營養(yǎng)）進食,因此尚無關于通過腸內營養(yǎng)治療胃癌的ERAS患者的數據。目的:當前的研究旨在分析來自幾項觀察性隊列研究的可用證據,然后進行一項回顧性研究,以對飼管的重要性及其在ERAS指導下的益處進行回顧性研究。方法:所有分析均由Review Manager（Rev-Man）5.3、（SPSS）22版或（S... 

【文章來源】：江蘇大學江蘇省

【文章頁數】：80 頁

【學位級別】：碩士

【文章目錄】：
ABSTRACT
摘要
CHAPTER1:INTRODUCTION
    1.1 CURRENT AND FUTURE IMPLEMENTATION OF ERAS PATHWAYS
    1.2 PRE-OPERATIVE PERIOD
        1.2.1 Information
        1.2.2 Optimization
        1.2.3 Physiotherapy
        1.2.4 Nutrition support
        1.2.5 Mechanical bowel preparation
        1.2.6 Fasting
        1.2.7 Opioid sparing
    1.3 OPERATIVE PERIOD
        1.3.1 Prophylactics
        1.3.2 Anaesthesia
        1.3.3 Surgical stress
        1.3.4 Fluid therapy
        1.3.5 Prophylactic feeding tubes
    1.4 POSTOPERATIVE PERIOD
        1.4.1 PONV
        1.4.2 Early oral feeding
        1.4.3 Balanced analgesia
        1.4.4 Early mobilization
    1.5 FEASIBILITY AND BENEFITS OF ERAS PATHWAYS
    1.6 CHALLENGES ARGUMENTS AND IMPROVEMENTS
    1.7 FUTURE DIRECTIONS
    1.8 SUMMARY
CHAPTER2:SHORT-TERM EVALUATION OF IMMUNE LEVELS AND NUTRITIONAL VALUES OF EN VERSUS PN IN GASTRIC CANCER:A SYSTEMATIC REVIEW AND A META-ANALYSIS
    2.1 BACKGROUND
    2.2 METHODS
        2.2.1 Retrieval strategy
        2.2.2 Inclusion and exclusion criteria
    2.3 STATISTICAL ANALYSIS
    2.4 RESULTS
        2.4.1 General characteristics
        2.4.2 Analysis of immune indicators
        2.4.3 Analysis of Nutrition indices
        2.4.4 Analysis of postoperative clinical outcomes
    2.5 ASSESSMENT OF PUBLICATION BIAS
    2.6 DISCUSSION
    2.7 CONCLUSIONS
    2.8 FUTURE DIRECTIONS
CHAPTER3:RETROSPECTIVE STUDY ON CLINICAL OUTCOMES OF GASTRIC CANCER PATIENTS UNDER MODIFIED NUTRITION IN ERAS
    3.1 BACKGROUND
    3.2 MATERIALS,METHODS AND ANALYSIS
        3.2.1 Enteral nutrition suspension and tube
        3.2.2 Inclusion and exclusion criteria
        3.2.3 Statistical analysis
    3.3 RESULTS
        3.3.1 Clinical indices
    3.4 DISCUSSION
CHAPTER4:GENERAL CONCLUSION AND RECOMMENDATIONS
    4.1 GENERAL CONCLUSION
    4.2 RECOMMENDATIONS
REFERENCES
LIST OF ABBREVIATIONS
LISTS OF PUBLICATIONS
ACKNOWLEDGEMENT
Study limitations
Ethics


【參考文獻】：
期刊論文
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[3]早期腸內營養(yǎng)與腸外營養(yǎng)在胃癌根治術后應用效果比較[J]. 劉洪一,王白石,張加金,張秉棟,薛勇敢,賈寶慶.  中國腫瘤臨床. 2014(18)
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