| BackgroundTrauma of gastric radical surgery can enhance the catabolism of patients with gastric cancer, and their body is in a state of immunosuppression. Malnutrition can have serious adverse effects on prognosis of patients with gastric cancer. Many studies have shown that early enteral nutrition is safe and feasible, and it can also effectively prevent and reduce the incidence of postoperative complications. However, in the course of its implementation, patients often have a variety of feeding intolerance. Feeding intolerance can restrict the wide application of early enteral nutrition. Sequential early enteral nutrition support is a new method of enteral nutrition. Research about sequential early enteral nutrition support is concentrated in field of stroke, relevant research is lack in field of gastric surgery. Research of early enteral nutrition is concentrated in clinical outcome, few studies concern economic indicators. Development of health economic policy and measures is paying more attention to the economics benefits of treatment.Objective1. To compare the clinical efficacy and cost between sequential early enteral nutrition support and non-sequential early enteral nutrition support after surgery of gastric cancer.2. To search for an enteral nutrition support program with a better effect and cost-effectiveness ratio, then, providing basis for the rational use of enteral nutrition after gastric cancer surgery.MethodsA randomized controlled trial from2012-10to2013-12of86patients who met the inclusion criteria were randomly divided into study group and control group. Sequential early enteral nutrition support therapy was used in study group, while non-sequential early enteral nutrition support was used in control group. Clinical monitoring indicators, including nutrition indicators, blood biochemistry indicators, immune and inflammatory markers, tolerance during enteral nutrition support, postoperative recovery of gastrointestinal function, surgical complications and postoperative hospital stay were compared between two groups. Health economics evaluation was also conducted, the average total cost of each group of postoperative hospital stay was used as cost for each group; Each index (tolerance during enteral nutrition support, postoperative recovery of gastrointestinal function, surgical complications and postoperative hospital stay) was converted into a comprehensive index(effectiveness index, EI) used as total effect for each group; Cost-effectiveness ratio(CER)=the total cost/EI. Results1. Comparison of the two groups in terms of sex, age, BMI, income type, method of payment, educational background, circumstances of residence and other respect are not having significant difference, P>0.05.2. Preoperative level of nutrition indicators, blood biochemistry indicators, immune and inflammatory markers of two groups are compared, and it is not having significant difference, P>0.05. Three days after operation, the levels of prealbumin in the study group was (161.7±24.5) g/L, and it was significantly higher than that in control group. Six days after operation, the levels of albumin and prealbumin in the study group were (33.7±3.9) g/L,(192.4±36.1) g/L, and it was significantly higher than that in control group. The differences were statistically significant, P<0.05. The intolerance incidence during enteral nutrition support in study group was15.6%, and the value of control group was31.7%. The length of postoperative hospital stay in study group was (8.5±2.6) d, and the value of control group was (10.4±2.8) d. The differences were statistically significant, P<0.05.3. The cost of study group was (10881±1393) yuan, the value of control group was (12894±1523) yuan, the cost of study group was lower than control group. Treatment index of study group was1.02, and the value of control group was0.98, the effect of study group was better than control group. The cost-effectiveness ratios of the study group and control group were10667.65,13157.14, respectively. The cost-effectiveness ratio of the study group was lower than control group, it suggested that to achieve the same therapeutic effect, the cost of the study group was lower than control group.Conclusion1. Sequential early enteral nutrition support therapy can improve the tolerability of the patients with early enteral nutrition, promote the improving of nutritional status and shorten the length of postoperative hospital stay.2. Compared with non-sequential early enteral nutrition support, sequential early enteral nutrition support has a better cost-effectiveness ratio. |
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