张旭刚, 李维青, 李宝重, 乔安邦, 李志田, 姜福胜. 基于倾向性评分匹配法比较食管癌术后早期肠内营养与肠外营养的疗效[J]. 中国肿瘤临床, 2019, 46(16): 832-835. DOI: 10.3969/j.issn.1000-8179.2019.16.856
引用本文: 张旭刚, 李维青, 李宝重, 乔安邦, 李志田, 姜福胜. 基于倾向性评分匹配法比较食管癌术后早期肠内营养与肠外营养的疗效[J]. 中国肿瘤临床, 2019, 46(16): 832-835. DOI: 10.3969/j.issn.1000-8179.2019.16.856
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Zhang Xugang, Li Weiqing, Li Baozhong, Qiao Anbang, Li Zhitian, Jiang Fusheng. Comparison of efficacy between early enteral nutrition and total parenteral nutrition after esophageal cancer surgery based on propensity score matching[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(16): 832-835. DOI: 10.3969/j.issn.1000-8179.2019.16.856
Citation: Zhang Xugang, Li Weiqing, Li Baozhong, Qiao Anbang, Li Zhitian, Jiang Fusheng. Comparison of efficacy between early enteral nutrition and total parenteral nutrition after esophageal cancer surgery based on propensity score matching[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(16): 832-835. DOI: 10.3969/j.issn.1000-8179.2019.16.856
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基于倾向性评分匹配法比较食管癌术后早期肠内营养与肠外营养的疗效

Comparison of efficacy between early enteral nutrition and total parenteral nutrition after esophageal cancer surgery based on propensity score matching

    摘要
  • 摘要:
      目的  综合评价并比较食管癌术后早期肠内营养（early enteral nutrition，EEN）和肠外营养（total parenteral nutrition，TPN）的临床疗效。
      方法  回顾性分析2011年3月至2019年3月在首都医科大学附属北京世纪坛医院行食管癌手术的患者237例，依据术后营养方式不同分为EEN组136例和TPN组101例，采用倾向性评分匹配功能进行匹配，比较匹配后两组患者的营养状况、肝功能、胃肠功能恢复情况、术后住院天数及并发症等指标。
      结果  采用1：1最邻近匹配法，经倾向性评分成功匹配91对患者。EEN组营养指标前白蛋白（prealbumin，PA）在术后7天明显优于TPN组（P < 0.05），而白蛋白（albumin，ALB）在术前、术后3、7天与TPN组比较无明显差异；EEN组的肝功能指标谷草转氨酶（ALT）、谷丙转氨酶（AST）在术后3天及7天显著优于TPN组（P < 0.05）；EEN组在放置胃管时间、排便时间、术后经口进食时间及术后住院天数均明显少于TPN组（P < 0.05）；EEN组反酸或呕吐、腹泻的发生率高于TPN组，而肺水肿、肺部感染的发生率低于TPN组，差异具有统计学意义（P < 0.05）。
      结论  与TPN相比，食管癌术后应用EEN的反酸或呕吐、腹泻发生率较高，但对肝功能影响小，能促进肠道功能恢复，改善患者的营养状况，缩短住院时间。

     

    Abstract:
      Objective  To evaluate and compare the clinical value of early enteral nutrition (EEN) and total parenteral nutrition (TPN) after esophageal cancer surgery.
      Methods  We retrospectively analyzed 237 patients who underwent esophageal cancer surgery at Beijing Shijitan Hospital from March 2011 to March 2019. They were assigned into two groups based on the postoperative nutritional support used:EEN (136 cases) and TPN (101 cases). Nutritional status, liver function, recovery of gastrointestinal function, days of hospitalization, and postoperative complications were compared between the two groups after propensity score matching.
      Results  Using 1:1 nearest neighbor matching, we successfully matched 91 pairs of patients. The prealbumin (PA) level was significantly higher in the EEN group than in the TPN group 7 days after surgery (P < 0.05); however, there was no significant difference in albumin (ALB) level before surgery, 3 or 7 days after surgery. Additionally, the levels of ALT and AST in the EEN group were significantly lower than those in the TPN group 3 and 7 days after surgery (P < 0.05). The incidence of acid reflux, vomiting, and diarrhea in the EEN group was higher than that in the TPN group, while the incidence of pulmonary edema and pulmonary infection was lower in the EEN group than in the TPN group (P < 0.05).
      Conclusions  Compared with TPN, EEN is associated with a high incidence of acid reflux, vomiting, and diarrhea after esophageal cancer surgery, but it has a lower impact on liver function. EEN can promote the recovery of intestinal function, improve nutritional indicators, and shorten hospitalization time.

     

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