早期腸道灌食對胃癌病人手術後營養狀態之影響

本研究探討接受胃癌手術病患，在術前給予足夠時間的全靜脈營養(total parenteral nutrition)支持。手術時，給予一腸造口的手術，作為早期腸道灌食(early enteral feeding)介入途徑，藉由此管灌食途徑，提供完整腸道營養，以評估營養介入之影響。於手術前1週接受全靜脈營養支持。手術後第一天透過空腸造口，進行早期腸道灌食。手術後為期14日之觀察天數及出院後3週後之評估。10位受試者，平均年齡為74.3歲，住院前之過去6個月平均體重減輕為12.4%。營養支持平均熱量需求為1635.6大卡，約30.3大卡/公斤體重；蛋白質需求為1.2公克/公斤體重。全靜脈營養支持平均使用19.6天。接受早期空腸灌食後，有6位出現腹脹、3位出現腹瀉之症狀，腹絞痛、嘔吐與吸入性肺炎未發生。追蹤出院後門診3週後之平均體重相較手術前體重有減少趨勢，但無統計意義。對於準備要接受胃癌手術體重明顯減輕的嚴重營養不良病患，給予七天以上的全靜脈營養支持，可維持病患之營養狀況且避免體重持續減輕；術後透過空腸造口給予早期腸道營養支持，對於血清中的血色素與血比容和鐵質有助上升趨勢，避免貧血情況惡化；由總淋巴球數的增加發現營養支持可以漸漸恢復病患之免疫功能。胃切除手術後，對於病患的營養照護應作長時間持續性的追蹤與評估，才可避免營養不良問題的產生或惡化。

關鍵字

胃癌；全靜脈營養支持；早期腸道灌食；空腸造口；腸道灌食

並列摘要

This study investigated the support of total parental nutrition (TPN) given pre-operatively to the patients with gastric cancer. The nutritional intervention was evaluated through the surgical jejunostomy as a route of early enteral feeding to provide sufficient enteral nutrition in gastric cancer patients. The patients received TPN one week prior to operation, and early enteral feeding through jejunostomy feeding on the first day of post-operation. The patients were observed for 14 days post-opreation and followed up after 3-week discharge. The subjects (n = 10) with the average age of 74.3 years old lost weight by 12.4% in the recent 6 months prior to operation. Their caloric requirement in average was 1635.6 kcal, which approximately equals to 30.3 kcal/kg body weight (BW). Protein requirement in average was 1.2 g/kg BW. The use of TPN was 19.6 days in average. There were 6 patients having bloating and 3 patients having diarrhea after receiving early enteral feeding. However, abdominal cramps, vomiting, and aspiration pneumonia had not occurred. The average body weight tended to decrease after 3-week discharge compared with that prior to operation. The support of TPN at least for 7 days in gastric cancer patients with significant weight loss and severe malnutrition going to receiving operation maintained the nutritional status and prevented continuous weight loss. The early enteral feeding through jejunostomy tended to increase serum hemoglobin, hematocrit, and iron levels to prevent deterioration from anemia. Additionally, nutritional support gradually improved the immune function of gastric cancer patients by increasing total lymphocyte counts. The nutritional care had better be continuously evaluated to prevent the occurrence and deterioration from malnutrition in gastric cancer patients with gastrectomy.

並列關鍵字

gastric cancer ； total parenteral nutrition ； early enteral feeding ； jejunostomy

參考文獻

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早期腸道灌食對胃癌病人手術後營養狀態之影響

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