| Objective:Through clinical observation to give early enteral nutrition after esophagectomy for patients with early enteral nutrition on intestinal mucosal barrier function in patients with influence, study for esophageal cancer surgery of intestinal mucosa barrier damage, and evaluation of early enteral nutrition on intestinal mucosa barrier of protection.Methods:According to the cases included in the standard prospective in June2011to October2012in Tianjin medical university general hospital thoracic surgeons do esophageal resection surgery in86patients with open thoracic exploration as the research object, were randomly divided into early enteral nutrition group(EEN group, N=46) and non-early enteral nutrition group (non-EEN group, N=40). EEN group within24h after surgery to give enteral nutrition, non-EEN group of postoperative enteral nutrition after48h.Observe the clinical results of two groups of patients in preoperative, postoperative days1,4,8, determination of two groups of patients with urinary ratio of lactulose and mannitol (L/M), serum type of intestinal fatty acid binding protein (I-FABP), plasma endotoxin (ET), diamine oxidase (DAO), and D-lactic acid (D-Lac) level, and record the postoperative infection complications and incidence of systemic inflammatory response syndrome (SIRS). Comparison of early postoperative enteral nutrition with the early enteral nutrition in patients with postoperative intestinal mucous membrane barrier function changes in different time points, the evaluation of postoperative early enteral nutrition on intestinal mucosal barrier function in patients with esophageal cancer surgery. Two groups of comparisons using t test statistical analysis; Rate of the chi-square test comparing applications; Using SPSS16.0statistical software for statistical analysis, P<0.05said have significant difference.Results:1. Comparison of L/M, I-FABP, ET, DAO, D-Lac(1) Comparison of L/M①EEN group comparison:postoperative day1L/M more significantly increased preoperative (0.956±0.232vs0.409±0.132), the difference was statistically significant (P <0.05); After4,8days began to gradually decline (0.737±0.219vs0.409±0.132),(0.539±0.185vs0.409±0.132), but still higher than that of preoperative levels, the difference was statistically significant (P <0.05).②non-EEN group comparison: postoperative day1L/M more preoperative obviously higher(0.981±0.249vs0.415±0.124), the difference was statistically significant (P <0.05); After4,8days began to gradually decline (0.898±0.234vs0.415±0.124),(0.787±0.204vs0.415±0.124), but still higher than that of preoperative levels, the difference was statistically significant (P <0.05).③Two groups of comparisonsxompared two groups of postoperative day1there was no statistically significant difference (P>0.05); EEN group was lower than the non-EEN group after4,8days (0.737±0.219vs0.898±0.234),(0.539±0.185vs0.787±0.204), the difference was statistically significant (P <0.05).(2) Comparison of I-FABP①EEN group comparison: postoperative day1I-FABP compared with preoperative obviously higher(4.83±0.32vsl.97±0.34), the difference was statistically significant (P <0.05); After4,8days began to gradually decline (3.44±0.39vsl.97±0.34),(2.05±0.27vsl.97±0.34), but still higher than that of preoperative levels, the difference was statistically significant (P <0.05).②non-EEN group comparison: postoperative day1I-FABP compared with preoperative obviously higher(0.471±0.249vsl.95±0.38), the difference was statistically significant (P <0.05); After4,8days began to gradually decline (3.69±0.33vsl.95±0.38),(2.52±0.24vsl.95±0.38), but still higher than that of preoperative levels, the difference was statistically significant (P <0.05).③Two groups of comparisons: compared two groups of postoperative day1there was no statistically significant difference (P>0.05); EEN group was lower than the non-EEN group after4,8days lower (3.44±0.39vs3.69±0.33),(2.05±0.27vs2.52±0.24), the difference was statistically significant (P <0.05).(3) Comparison of ET①EEN group comparison: postoperative day1ET compared with preoperative obviously higher(0.82±0.21vs0.36±0.13), the difference was statistically significant (P <0.05); After4,8days began to gradually decline (0.47±0.19vs0.36±0.13), (0.39±0.21vs0.36±0.13), but still higher than that of preoperative levels, the difference was statistically significant (P<0.05).②non-EEN group comparison:postoperative day1ET compared with preoperative obviously higher(0.76±0.27vs0.34±0.15), the difference was statistically significant (P<0.05); After4,8days began to gradually decline (0.56±0.17vs0.34±0.15),(0.52±0.18vs0.34±0.15), but still higher than that of preoperative levels, the difference was statistically significant (P<0.05).③Two groups of comparisons:compared two groups of postoperative day1there was no statistically significant difference (P>0.05); EEN group was lower than the non-EEN group after4,8days lower (0.47±0.19vs0.56±0.17),(0.39±0.21vs0.52±0.18), the difference was statistically significant (P<0.05).(4) Comparison of DAO①EEN group comparison:postoperative day1DAO more preoperative obviously higher(3.72±0.22vs1.97±0.17), the difference was statistically significant (P<0.05); After4,8days began to gradually decline (3.06±0.20vsl.97±0.17),(2.57±0.24vs1.97±0.17), but still higher than that of preoperative levels, the difference was statistically significant (P<0.05).②non-EEN group comparison:postoperative day1DAO more preoperative obviously higher(3.76±0.25vs1.99±0.15), the difference was statistically significant (P<0.05); After4,8days began to gradually decline (3.49±0.21vs1.99±0.15),(3.11±0.19vs1.99±0.15), but still higher than that of preoperative levels, the difference was statistically significant (P<0.05).③Two groups of comparisons:compared two groups of postoperative day1there was no statistically significant difference (P>0.05); EEN group was lower than the non-EEN group after4,8days Iower(3.06±0.20vs3.49±0.21),(2.57±0.24vs3.11±0.19), the difference was statistically significant (P<0.05).(5) Comparison of D-Lac①EEN group comparison:postoperative day1D-Lac than preoperative obviously higher (16.54±5.06vs7.55±3.67), the difference was statistically significant (P<0.05); After4,8days began to gradually decline(12.26±4.23vs7.55±3.67),(9.67±3.24vs7.55±3.67), but still higher than that of preoperative levels, the difference was statistically significant (P<0.05).②non-EEN group comparison:postoperative day1D-Lac than preoperative obviously higher(16.88±5.35vs7.53±3.72), the difference was statistically significant (P<0.05); After4,8days began to gradually decline (15.61±4.43vs7.53±3.72),(13.35±3.67vs7.53±3.72), but still higher than that of preoperative levels, the difference was statistically significant (P<0.05).③Two groups of comparisons:compared two groups of postoperative day1there was no statistically significant difference (P>0.05); EEN group was lower than the non-EEN group after4,8days a lower (12.26±4.23vs15.61±4.43),(9.67±3.24vs13.35±3.67), the difference was statistically significant (P<0.05).2. Comparison of clinical indicatorsEEN group and non-EEN group in patients with postoperative infection complication rate (10.8%vs27.5%), the difference was statistically significant (P<0.05); Have SIRS occurs in both groups, but EEN group was lower than the non-EEN group at postoperative48days, incidence of SIRS is low (11%vs22%,7%vs15%), the difference was statistically significant (P<0.05).Conclusion:1. Early postoperative esophageal cancer patients is barrier function of intestinal mucosa damage, postoperative enteral nutrition support have a certain protective effect on intestinal mucosal barrier function.2. Giving the enteral nutrition support in patients with esophageal cancer postoperative intestinal mucous membrane barrier function has more obvious protective effect.3.Come into force as of early postoperative enteral nutrition can effectively maintain intestinal mucosal barrier function in patients with esophageal cancer, reduce bacterial and endotoxin translocation, thus reducing SIRS and infection complications, to improve clinical outcomes. |
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