Influence of Early Enteral Nutrition (EEN) on Insulin Resistance in Gastric Cancer Patients after Surgery

目的：評估早期腸道營養對於降低術後胃癌病人胰島素抗性之效益。方法：將術後的胃癌病人隨機分成接受傳統全靜脈營養（A組）或早期腸道營養（B組）。術後24小時，利用管灌給予B組病人250－500毫升5%氯化鈉和葡萄糖；從48小時開始，利用幫浦以連續灌食方式給予腸道營養液，以每小時20毫升的流速緩慢增加至每小時100毫升，接著再轉換至完全腸道營養給予。在術前、術後24、48、72、120和168小時，利用Quicki法檢測病人之胰島素敏感性。結果：共有77位病人參與本試驗，A組42人、B組35人。兩組之基本特性、生化指標、以及手術性質大致相同。藉由兩組在不同時間點所測得的胰島素敏感性曲線指出，胃癌病人在術後早期（第1天到第7天）即出現胰島素抗性，且手術前後有顯著差異。在調整身體質量指數、年齡和術前72、102小時及術後168小時的胰島素敏感性，發現B組病人的胰島素敏感性顯著高於A組。結論：早期腸道營養的施行可減輕術後胃癌病人之胰島素抗性。

關鍵字

早期腸道營養；胃癌；胰島素抗性；胰島素敏感性；葡萄糖耐受性

並列摘要

Objective: To evaluate the benefits of reducing insulin resistance by early enteral nutrition (EEN) in gastric cancer patients after surgery. Methods: Gastric cancer patients were managed to randomly accept traditional total parenteral nutrition (group A) or EEN (group B) after surgical treatment. The patients in group B were fed by tubes with 250-500 mL 5% sodium chloride and glucose injection at 24 h post-surgery, and were fed enteral nutritional emulsion with constant infusion by pump slowly increasing from 20 mL/h to 100 mL/h from 48 h, and then transiting to total enteral nutrition. Insulin sensitivity of patients was detected by Quicki method before operation and at 24 h, 48 h, 72 h, 120 h and 168 h post-surgery. Results: A total of 77 patients were enrolled, with 42 patients in group A, and 35 patients in group B. Baseline characteristics, biochemical indexes and operational characteristics were well balanced between two groups. The time-insulin sensitivity curves of the two groups indicated that IR was present early (day 1 to day 7) in gastric cancer patients and was significantly different between patients who had undergone surgical treatment and those who had not. Insulin sensitivity (SI) of patients in group B were higher than patients in group A with adjusting BMI, age and SI preoperative at 72 h, 120 h and 168 h post-surgery. Conclusions: The management of EEN can alleviate insulin resistance in gastric cancer patients with surgical treatment.

並列關鍵字

early enteral nutritional ； gastric cancer ； insulin resistance ； insulin sensitivity ； Glucose tolerance

參考文獻

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國際替代計量

Influence of Early Enteral Nutrition (EEN) on Insulin Resistance in Gastric Cancer Patients after Surgery

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