Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection.

OBJECTIVES: To assess whether immediate post-operative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective. DESIGN: Randomised trial of immediate post-operative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet. SETTING: Teaching hospitals in London. SUBJECTS: 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection. MAIN OUTCOME MEASURES: Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome. RESULTS: Successful immediate enteral feeding was established in all 14 patients with a mean (SD) daily intake of 6.78 (1.57)MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P < 0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) - 13.2 (11.6) g v 5.3 (2.7) g; P < 0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11(0.06) v 0.15 (0.12); P < 0.005). There were also fewer postoperative complications in the enterally fed group (P < 0.005). CONCLUSIONS: Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.     

燕麦米汤对严重烧伤患者休克期肠道复苏的影响

目的：研究严重烧伤患者休克期经肠道给予燕麦米汤对肠道复苏的影响。方法：选取烧伤面积≥30%TBSA的患者42例,并随机分为：燕麦米汤组,伤后24h内开始经鼻肠管给予燕麦米汤;对照组,伤后24h内开始经鼻肠管给予50g/L葡萄糖盐水,连续4d,每组21例。在伤后1、2、3、4 d分别检测其血清二氨氧化酶（DAO）值及动脉血乳酸（LAC）含量,观察两组患者腹胀缓解时间、肠鸣音恢复时间等临床指标。结果：两组患者伤后血清二氨氧化酶及动脉血乳酸含量均呈下降趋势,燕麦米汤组血清二氨氧化酶在伤后2、3、4d显著低于对照组（P〈0.01）,而脉血乳酸含量在伤后2、3d显著低于对照组（P〈0.05或0.01）,治疗过程中燕麦米汤组其腹胀缓解时间、肠鸣音恢复时间、排气时间、开始完全肠内营养时间、继发感染例数均优于对照组（P〈0.01）。结论：在严重烧伤休克期尽早鼻饲燕麦米汤能较好地促进肠道复苏。     

微生态制剂联合肠内营养对食管癌患者术后肠功能及营养状况的影响

目的 探讨微生态制剂联合肠内营养对食管癌患者术后肠功能及营养状况的影响。 方法 选取2018年6月至2018年12月我院胸外科食管癌术后患者58例,随机分为观察组(n=27)和对照组(n=31)。对照组患者术后采用常规肠内肠外联合营养支持方案,观察组患者在对照组基础上给予微生态制剂(活菌型乳酸菌乳饮品)鼻饲。比较两组患者腹胀、腹泻的发生率,通气时间,首次排便时间,留置胃管时间,住院时间,住院总费用,血红蛋白、前白蛋白、转铁蛋白、白蛋白、视黄醇结合蛋白水平及出院时BMI值的变化。 结果 观察组患者术后发生腹胀和腹泻的比率明显低于对照组,通气时间、首次排便时间均早于对照组(P结论 微生态制剂(活菌型乳酸菌乳饮品)联合肠内营养能改善食管癌患者术后的肠功能,降低肠内营养不耐受的发生率,有利于肠内营养的实施,促进患者康复。     

深度水解蛋白配方奶在不同体重早产儿喂养中的临床效果观察

目的:评估深度水解配方奶(eHPF)在不同体重早产儿早期喂养中临床应用效果。方法:选取2017年9月至2018年12月出生的早产儿,分为极低出生体重儿组(体重1000-1500g之间)62例和低出生体重儿(体重1500-2000g之间)100例,每组再随机分为两组,分别予以深度水解蛋白奶(eHPF)和早产儿配方奶(SPF)喂养。极低出生体重儿组于12小时后开始微量喂养,低出生体重儿12小时内适量喂养;极低出生体重儿组深度水解蛋白奶喂养2周后改早产儿奶喂养,低出生体重儿组深度水解蛋白奶1周后改早产儿奶喂养。比较深度水解蛋白奶在不同体重早产儿早期喂养中的临床应用效果,不同体重早产儿恢复出生体重时间、每日体重增长速度、胃管留置时间、完全肠内喂养天数、住院天数、喂养不耐受发生率、宫外发育迟缓发生率及尿素氮、碱性磷酸酶指标。结果:深度水解蛋白喂养组极低出生体重儿/低出生体重儿恢复出生体重天数、完全肠道喂养天数、胃管留置时间、住院天数较早产儿奶喂养组明显缩短(P0.05),每天体重增长优于早产儿组,喂养不耐受、宫外发育迟缓发生率明显低于早产儿组(P0.05),尿素氮、碱性磷酸酶无统计学差异(P0.05)。结论:深度水解蛋白奶用于不同体重早产儿早期喂养效果明显优于早产儿配方奶,其更有助于早产儿的生长发育。     

腹腔镜探查并治疗腹部恶性肿瘤术后肠梗阻的临床研究

目的:探讨腹腔镜辅助探查并治疗腹部恶性肿瘤术后肠梗阻患者的可行性及安全性。方法:应用腹腔镜技术对我院42例腹部恶性肿瘤术后患者行手术治疗,其中包括良性粘连性肠梗阻14例、肿瘤复发16例、原发性结肠癌1例、恶性肠粘连11例。结果:42例患者均在腹腔镜下明确诊断,其中18例患者在完全腹腔镜下手术治疗,13例患者在腹腔镜辅助下行手术治疗,6例患者腹腔严重粘连中转开腹手术治疗,5例患者腹腔广泛转移行保守治疗。腹腔镜手术时间为35~290min,平均住院日9.2±1.7d。患者术后疼痛较轻、下床活动时间及肠道功能恢复时间短、术后并发症少。结论:恶性肿瘤术后肠梗阻患者仍需手术治疗,在严格掌握手术适应症下,应用腹腔镜技术对恶性肿瘤术后肠梗阻病人的治疗是安全、可行的。     

Early postoperative feeding with elemental diet.

The value of early postoperative feeding with an elemental diet was assessed in 30 patients after major gastrointestinal operations. The patients were allocated at random to conventional treatment (control group) or feeding with the elemental diet (ED group). The clinical and metabolic course of the 15 patients in the ED group was significantly better than that of the controls. Patients in the ED group lost less weight and had a shorter stay in hospital. Negative nitrogen balance was more pronounced in the control group throughout the seven postoperative days. Energy intake was higher in the ED group. Provided elemental feeding is used with caution, it may be given from the first postoperative day. Patients do better metabolically and require shorter stays in hospital.     

经皮内镜下空肠造口术在胃癌术后胃排空障碍治疗中的应用

目的:报道经皮内镜下空肠造口术在胃癌术后胃排空障碍治疗中行胃减压及肠内营养支持的治疗效果。方法:28例胃癌术后胃排空障碍的病人在局麻或基础麻醉下行经皮內镜下空肠造口术,术后行胃减压及肠内营养支持?峁?28例患者均操作成功,平均操作时间为(19.5±4.6)min,无严重导管相关并发症。术后第2天开始通过空肠营养管进行肠内营养,平均术后(7.3土1.6)天完全摆脱肠外营养支持。术后平均(19.4土7.7)天恢复胃动力夹闭胃引流管。平均留置时间(35.8士11.8)天,拔管时营养状况较术前明显改善。结论:皮内镜下空肠造口术在胃癌术后胃排空障碍的治疗中能够起到有效的胃减压和营养支持,明显改善患者生活质量。     

不同营养支持方式对进展期胃癌术后病人临床结局比较

摘要目的：研究肠内营养、肠外营养、常规补液对胃癌术后患者临床结局的影响。方法：择我院住院治疗并行外科手术治疗的胃 癌患者183 例,随机分至肠内营养组、肠外营养组、常规补液组,分别行相应的营养支持治疗,比较三组患者术前/ 后1 天及术后 8 天体重、白蛋白、淋巴细胞计数的变化及术后并发症发生情况、营养支持费用、术后住院时间、总费用。结果：常规补液组术后第 8 天体重较术前1 天明显下降;肠内、肠外营养组患者体重下降幅度均明显低于常规补液组;肠内、肠外营养组术后第8 天白蛋白 水平升高显著,且明显高于常规补液组;肠内营养组患者术后第8 天淋巴细胞明显上升,且较常规补液组有明显升高。肠外营养 组、常规补液组患者肝功能损害、血脂升高、血糖升高的发生率均明显高于肠内营养组;肠外营养组患者肝功能损害、血脂升高发 生率明显低于常规补液组;肠内营养组患者切口腹腔感染及肺部感染的发生率均明显低于常规补液组。与常规补液组相比,肠 外、内营养组患者术后住院时间均明显缩短,肠内营养组患者总费用明显偏高;与肠外营养相比,肠内营养组、常规补液组营养支 持费用明显降低,肠内营养组患者总费用显著下降,上述差异均有统计学意义（P＜0.05）。结论：胃癌术后患者行肠内营养可大大 降低术后并发症的发生,并减少患者住院费用,缩短术后住院时间。     

不同营养支持方式对进展期胃癌术后病人临床结局比较

目的：研究肠内营养、肠外营养、常规补液对胃癌术后患者临床结局的影响。方法：择我院住院治疗并行外科手术治疗的胃癌患者183例,随机分至肠内营养组、肠外营养组、常规补液组,分别行相应的营养支持治疗,比较三组患者术前／后1天及术后8天体重、白蛋白、淋巴细胞计数的变化及术后并发症发生情况、营养支持费用、术后住院时间、总费用。结果：常规补液组术后第8天体重较术前1天明显下降;肠内、肠外营养组患者体重下降幅度均明显低于常规补液组;肠内、肠外营养组术后第8天白蛋白水平升高显著,且明显高于常规补液组;肠内营养组患者术后第8天淋巴细胞明显上升,且较常规补液组有明显升高。肠外营养组、常规补液组患者肝功能损害、血脂升高、血糖升高的发生率均明显高于肠内营养组;肠外营养组患者肝功能损害、血脂升高发生率明显低于常规补液组;肠内营养组患者切口腹腔感染及肺部感染的发生率均明显低于常规补液组。与常规补液组相比,肠外、内营养组患者术后住院时间均明显缩短,肠内营养组患者总费用明显偏高;与肠外营养相比,肠内营养组、常规补液组营养支持费用明显降低,肠内营养组患者总费用显著下降,上述差异均有统计学意义（P〈O．05）。结论：胃癌术后患者行肠内营养可大大降低术后并发症的发生,并减少患者住院费用,缩短术后住院时间。     

添加益生菌的早期滋养量肠内营养对重症脑卒中患者呼吸机相关性肺炎的影响

目的 探讨早期给予添加益生菌的滋养量肠内营养（EN）对重症脑卒中患者呼吸机相关性肺炎（VAP）的影响。方法 选择2015年10月1日至2017年10月1日我院神经内科收治的接受鼻饲饮食及机械通气的重症脑卒中患者56例,随机分为对照组和观察组各28例。对照组患者在入院48 h内给予早期肠内营养支持治疗,观察组在对照组基础上常规给予双歧杆菌乳杆菌三联活菌片鼻饲,并给予滋养量肠内营养支持治疗（起始量10~20 mL鼻饲低速泵入）。比较两组患者治疗后肠内营养达标时间、肠内营养并发症发生率、营养状态指标、炎症因子水平、呼吸机相关性肺炎发生率、脱机成功率及病死率。结果 治疗后,观察组患者腹胀、腹泻、应激性高血糖发生率较低,肠内营养达标时间较短。同时观察组患者血清白蛋白、前白蛋白、淋巴细胞计数均高于对照组,血WBC、CRP、PCT水平均低于对照组。观察组患者脱机成功率相对较高,呼吸机相关性肺炎发生率相对较低。观察组患者GCS评分、APACHEⅡ评分及病死率相对较低,但差异均无统计学意义（P>0.05）。结论 早期给予添加益生菌的滋养量肠内营养有助于提高患者肠内营养的耐受性,改善患者营养状态,降低炎性因子水平,有助于减少呼吸机相关性肺炎发生率。     

益生菌联合早期肠内营养对合并应激性高血糖的重症脑卒中患者血糖调控及预后的影响

目的 探讨益生菌联合早期肠内营养(EEN)对合并应激性高血糖的重症脑卒中患者血糖调控及预后的影响,为此类患者的治疗提供参考。 方法 选择2017年5月1日至2019年5月1日我院神经内科收治的合并应激性高血糖的重症脑卒中患者64例为研究对象,随机分为对照组和观察组,各32例。对照组患者在入院48 h内给予EEN,观察组患者在对照组基础上给予双歧杆菌乳杆菌三联活菌片鼻饲。比较两组患者治疗后血糖变异性、胰岛素使用强度、低血糖发生率、炎症反应指标水平、应激反应指标水平、胃肠道不良反应,5 d内肠内营养达标率、营养状态指标水平、医院获得性肺炎(HAP)发生率及病死率。 结果 治疗后,观察组患者血糖变异性较小,胰岛素使用强度降低,低血糖发生率降低,炎症反应指标、应激反应指标水平均低于对照组;胃肠道不良反应中腹泻发生率降低,肠内营养达标率升高,血清白蛋白、前白蛋白水平均高于对照组,医院获得性肺炎发生率降低。两组患者病死率差异无统计学意义(12.50% vs 18.75%;χ2=0.474,P=0.491)。 结论 对于合并应激性高血糖的重症脑卒中患者,益生菌联合EEN有助于控制血糖稳定性,降低胰岛素使用强度及低血糖发生率,同时降低炎症及应激反应,提高患者肠内营养耐受性,改善患者营养状态,降低HAP发生率。     

Timing of enteral feeding in cerebral malaria in resource-poor settings: a randomized trial

Background

Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia.

Method and Findings

A randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia.

Conclusions

In conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.

Trial Registration

Controlled-Trials.com ISRCTN57488577     

Temporal proteomic analysis of intestine developing necrotizing enterocolitis following enteral formula feeding to preterm pigs

Necrotizing enterocolitis (NEC), a serious gastrointestinal inflammatory disease, frequently occurs in preterm neonates that fail to adapt to enteral nutrition. A temporal gel-based proteomics study was performed on porcine intestine with NEC lesions induced by enteral formula feeding. Functional assignment of the differentially expressed proteins revealed that important cellular functions, such as the heat shock response, protein processing; and purine, nitrogen, energy metabolism, were possible involved in the early progression of NEC.     

胃癌术后早期经鼻空肠营养管肠内营养患者的强化护理的临床效应

目的:探讨强化护理措施对胃癌患者术后营养状态的改善作用,为减少术后营养相关并发症的发生提供可借鉴的方法。方法:选择2012年1月-2013年12月在我科实施胃癌手术患者的临床资料进行分析,根据术后营养支持方式的不同,将患者分为早期肠内营养支持组和常规肠内营养组。观察并比较两组患者的生命体征变化、术后肛门排气时间及并发症的发生情况等。结果:强化护理组23例胃癌患者给予术后早期肠内营养治疗后,恢复肛门排气时间为53±7.4 h,经过5±2.1 d的肠内营养后,术后体重增加1.2±0.4 kg,无肠内营养相关并发症发生,肠外营养支持时间明显缩短。结论:本研究显示强化早期肠内营养护理具有迅速改善胃癌病人营养不良状态,减少营养不良相关并发症发生,减轻病人经济负担等优点。     

母乳联合鼠李糖乳杆菌预防早产儿喂养不耐受的疗效观察

目的 观察母乳联合鼠李糖乳杆菌预防早产儿喂养不耐受的临床疗效。方法 选取2016年2月至2017年2月武汉大学人民医院收治的80例生后24 h内入住本院儿科新生儿病房的早产儿,随机分配成2组,其中研究组40例,对照组40例。研究组以新鲜母乳联合鼠李糖乳杆菌早期开奶喂养,对照组以早产儿配方奶早期开奶喂养,比较2组早产儿喂养不耐受症的发生率及其恢复出生体重时间、达全胃肠道喂养时间、体重增长速度和住院时间的差异。结果 研究组患儿喂养不耐受发生率低于对照组,研究组恢复出生体重时间、达全胃肠道喂养时间及住院时间均短于对照组（P<0.05）,研究组患儿体重增加速度快于对照组（P<0.05）。结论 早产儿早期喂养母乳联合鼠李糖乳杆菌能够较早建立全胃肠道营养,减少早产儿喂养不耐受症的发生率,促进患儿体重增长,缩短恢复出生体重时间及达全胃肠道喂养时间,降低住院天数。     

Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials

ObjectiveTo determine whether a period of starvation (nil by mouth) after gastrointestinal surgery is beneficial in terms of specific outcomes.DesignSystematic review and meta-analysis of randomised controlled trials comparing any type of enteral feeding started within 24 hours after surgery with nil by mouth management in elective gastrointestinal surgery. Three electronic databases (PubMed, Embase, and the Cochrane controlled trials register) were searched, reference lists checked, and letters requesting details of unpublished trials and data sent to pharmaceutical companies and authors of previous trials.ResultsEleven studies with 837 patients met the inclusion criteria. In six studies patients in the intervention group were fed directly into the small bowel and in five studies patients were fed orally. Early feeding reduced the risk of any type of infection (relative risk 0.72, 95% confidence interval 0.54 to 0.98, P=0.036) and the mean length of stay in hospital (number of days reduced by 0.84, 0.36 to 1.33, P=0.001). Risk reductions were also seen for anastomotic dehiscence (0.53, 0.26 to 1.08, P=0.080), wound infection, pneumonia, intra-abdominal abscess, and mortality, but these failed to reach significance (P>0.10). The risk of vomiting was increased among patients fed early (1.27, 1.01 to 1.61, P=0.046).ConclusionsThere seems to be no clear advantage to keeping patients nil by mouth after elective gastrointestinal resection. Early feeding may be of benefit. An adequately powered trial is required to confirm or refute the benefits seen in small trials.

What is already known on this topic

Enteral feeding within 24 hours after gastrointestinal surgery is toleratedTheoretically, early enteral feeding improves tissue healing and reduces septic complications after gastrointestinal surgery

What this study adds

There is no benefit in keeping patients “nil by mouth” after gastrointestinal surgerySeptic complications and length of hospital stay were reduced in those patients who received early enteral feedingIn patients who received early enteral feeding there were no significant reductions in incidence of anastomotic dehiscence, wound infection, pneumonia, intra-abdominal abscess, and mortality     

Phenytoin absorption in volunteers receiving selected enteral feedings.

Phenytoin absorption is reportedly significantly altered in the presence of continuously administered enteral feedings, resulting in subtherapeutic serum phenytoin concentrations and loss of seizure control. We administered 500 mg of phenytoin as the suspension to five volunteers who were not receiving enteral feeding, again while they ingested protein hydrolysate enteral feedings hourly, and again during hourly ingestions of meat-base enteral feeding. Serum phenytoin concentrations, measured 3, 6, 9, 12, and 24 hours after phenytoin ingestion, were lowest with protein hydrolysate feedings. Mean serum phenytoin concentrations were consistently higher with the meat-base feeding than with the protein hydrolysate formula, although levels did not reach those of the control period. These data are in keeping with our previous observation that it is easier to attain therapeutic serum phenytoin concentrations in patients receiving a meat-base enteral feeding than in those receiving a protein hydrolysate formula.     

Delayed development of interstitial cells of Cajal in the ileum of a human case of gastroschisis

The Interstitial Cells of Cajal (ICC) are responsible for rhythmic electrical activity. A paralytic ileus is present in gastroschisis (GS), a malformation due to a defective closure of the abdominal wall through which part of the intestine herniates during pregnancy. In experimental GS, ICC morphological immaturity was shown in the rat foetus at-term but it could not be demonstrated whether differentiation is accomplished post-natally. For this purpose we morphologically investigated ICC, as well as enteric neurons and smooth muscle cells, in a case of human GS at birth and 1 month later when peristaltic activity had initiated. A 36 weeks gestation female was born by c/section with prenatal diagnosis of GS and possible volvulus of the herniated intestine. At birth, the necrotic intestine was resected and both ileostomy and colostomy were performed. The intestine continuity was restored after 4 weeks. Intestinal specimens, taken during both operations at the level of the proximal stoma, were immunostained with c-kit, neuron-specific-enolase and alpha-smooth-muscle-actin antibodies and some processed for electron microscopy. ICC were present at the myenteric plexus only. At birth, these cells were rare and ultrastructurally immature; 1 month later, when partial enteral feeding was tolerated, they formed rows or groups and many of them were ultrastructurally differentiated. Neurons and smooth muscle cells, immature at birth, had developed after 1 month. Therefore, ICC differentiation, as well as that of neurons and smooth muscle cells, is delayed at birth and this might explain the paralytic ileus in GS. One month later, differentiation quickly proceeded at all cellular levels paralleling the increasing tolerance of enteral nutrition.     

Transition from parenteral to enteral nutrition induces immediate diet-dependent gut histological and immunological responses in preterm neonates

Necrotizing enterocolitis (NEC) in preterm infants develops very rapidly from a mild intolerance to enteral feeding into intestinal mucosal hemorrhage, inflammation, and necrosis. We hypothesized that immediate feeding-induced gut responses precede later clinical NEC symptoms in preterm pigs. Fifty-six preterm pigs were fed total parenteral nutrition (TPN) for 48 h followed by enteral feeding for 0, 8, 17, or 34 h with either colostrum (Colos, n = 20) or formula (Form, n = 31). Macroscopic NEC lesions were detected in Form pigs throughout the enteral feeding period (20/31, 65%), whereas most Colos pigs remained protected (1/20, 5%). Just 8 h of formula feeding induced histopathological lesions, as evidenced by capillary stasis and necrosis, epithelial degeneration, edema, and mucosal hemorrhage. These immediate formula-induced changes were paralleled by decreased digestive enzyme activities (lactase and dipeptidylpeptidase IV), increased nutrient fermentation, and altered expression of innate immune defense genes such as interleukins (IL-1α, IL-6, IL-18), nitric oxide synthetase, tight junction proteins (claudins), Toll-like receptors (TLR-4), and TNF-α. In contrast, the first hours of colostrum feeding induced no histopathological lesions, increased maltase activity, and induced changes in gene expressions related to tissue development. Total bacterial density was high after 2 days of parenteral feeding and was not significantly affected by diet (colostrum, formula) or length of enteral feeding (8-34 h), except that a few bacterial groups (Clostridium, Enterococcus, Streptococcus species) increased with time. We conclude that a switch from parenteral to enteral nutrition rapidly induces diet-dependent histopathological, functional, and proinflammatory insults to the immature intestine. Great care is required when introducing enteral feeds to TPN-fed preterm infants, particularly when using formula, because early feeding-induced insults may predispose to NEC lesions that are difficult to revert by later dietary or medical interventions.     

益生菌联合肠内营养对食管癌患者术后胃肠功能的影响

目的 探讨益生菌联合肠内营养对食管癌患者术后胃肠功能的影响。方法 50例食管癌患者按随机数字表法被分为对照组（24例）和试验组（26例）。对照组患者采用常规治疗方案,并同时实施肠内营养治疗。试验组患者在对照组治疗的基础上给予鼻饲益生菌。观察并比较两组患者腹胀、腹泻、便秘、胃内容物反流、胃潴留等不良反应的发生情况;留置胃管、留置鼻肠营养管及达到肠内营养目标喂养量的时间;患者入院时和出院时体重的变化以及两组患者住院时间及住院费用。结果 试验组患者腹胀、便秘、胃潴留的发生率均明显低于对照组,差异有统计学意义（P<0.05）。两组患者腹泻、胃内容物反流的发生率差异无统计学意义（P<0.05）。试验组患者达到肠内营养目标喂养量的时间显著短于对照组（P<0.05）。试验组患者留置胃管时间和留置鼻肠营养管的时间明显短于对照组（P<0.05）。对照组患者出院时体重较入院时明显降低,与试验组相比差异有统计学意义（P<0.05）。试验组患者的住院时间和住院费用均低于对照组,但差异无统计学意义（P<0.05）。结论 肠内营养联合益生菌具有协同治疗作用,可有效降低食管癌患者术后胃肠道不良反应的发生率,促进患者肠内营养的实施,保证患者机体的营养需要。