老年胃癌患者全胃切除后早期肠内膳食纤维素营养液的作用

目的　探讨老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液肠内营养 (EN)的可行性。方法　 5 0例 6 0岁以上胃癌全胃切除患者 ,随机分为实验组 2 5例 ,用能全力 (TPF) 9d ;对照Ⅰ组 2 5例 ,用等氮、等热卡、等时间肠外营养 (PN)。另随机抽取同期 6 0岁以下同样患者 2 5例为对照Ⅱ组 ,支持方法和时间与实验组相同。结果　①营养指标。三组患者体重、三角肌皮折厚度、肌酐身高比、白蛋白 ,手术后第 9天都分别恢复到近于手术前 1d水平 (P >0 .0 5 ) ,仅谷氨酰胺对照Ⅰ组降低明显 (P <0 .0 5 )。术后第 4天至第 9天氮累积水平对照Ⅰ组也较低 (P<0 .0 5 )。②安全性。全部患者均无严重不良反应 ,都安全渡过术后恢复期。实验组比对照Ⅰ组肛门排气恢复显著提前 (P <0 .0 1)。结论　老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液EN ,安全适宜 ,效果良好 ,和较年轻患者近似 ,比同龄患者PN疗效高。

The application of early intestinal prandial-fibrin-liquid after complete gastrectomy for patients of gastric carcinoma

Objective To study the feasibility of early complete fibrin intestinal sustaining available for the senior patients of gastric carcinoma complete gastrectomy. Methods Fifty patients above 60 years old were divided into 2 groups randomly: study group who were remedied by TPF as intestinal sustaining available for 9 days after the operation and control group Ⅰ remedied by alimentation fluids peri intestinally (PN), and the nitrogen and calories contents were the same as TFP for 9 days. For comparison, meanwhile, the other 25 patients were chosen as control group Ⅱ of below 60 years old receiving the same remedy as the study group. Results ①Nutrition index: in addition to decreasing remarkably in glutamine for the patients of control group Ⅰ ( P <0.05), the weight, thickness of deltoid skin pucker, ratio of creatinine to height, and serum albumin level, were all restored to the level before operation for patients of the three groups ( P >0.05) 9 days after the operation. ②Safety of the therapy: no undesired side effects occurred in the three groups of patients of gastrectomy. They got safely through recovery period after operation. Bowel movements of the patients in study group were obviously earlier than those in control group Ⅰ( P <0.01). Conclusion Early intestinal complete fibrin sustaining therapy is safe and effective for senior patients of gastric carcinoma during the rehibilitation period after complete gastrectomy. The curative effects is similar to that for younger patients and better than that for patients of the same age.