Clinical Application And Curative Effect Evaluation Of Special Enteral Nutrition After The Operation Of Gastric Cancer With Diabetes

[Objective] Postoperative nutritional support for patients with gastric cancer and diabetes with different nutritional pathways,Comparison and analysis of the effects and clinical significance of different nutritional ingredients and nutritional support methods of the course of inflammation ? the Maintenance of immune function and the recovery of gastrointestinal function after the operation of gastric cancer patients with diabetes.The result,summarize the clinical experience,provide a reference for selection of such patients with postoperative nutritional management.[Methods] Group in our hospital underwent surgical treatment of 60 cases of gastric cancer complicated with diabetes,random grouping of nutrients and nutrients in patients after surgery into partial parenteral nutrition group(PPN),early Enteral Nutritional Suspension group(EEN)and diabetic special Enteral Nutritional Emulsion(TPF-D)group for diabetics.Group PPN patients were given full parenteral nutrition(TPN)for 1-2 days through the peripheral vein to central vein(PICC),Then take a partial addition of parenteral nutrition support for 7-10 days;The patients in group EEN and group TPF-D provided nutrition for Enteral Nutritional Suspension and diabetes special nutrition emulsion by enteral nutrition support,the changes of blood sugar,nutrition,immunity and inflammation were observed and compared in the three groups of different groups after operation,analysis the effects and clinical efficacy of different nutrient routes on postoperative recovery of patients with gastric cancer and diabetes mellitus.The nutritional indicators include: The body mass index(BMI)before the operation and the 1th,the 4th,and the 10 th days after the operation;The level of serum protein(including prealbumin,total protein,albumin);the Lymphocyte count(LYM);The blood sugar control indicators include;the preoperation fasting and 2-hour postprandial blood glucose after three meals of the 1th,the 4th,and the 10 th days after the operation corresponded to the blood sugar values at four time points.Inflammatory and immune indicators,the leukocyte count(WBC)was included the 1th,the 4th,and the 10 th days after the operation and the result before the operation,the level of C-reactive protein(CRP),the Lymphocyte count;Gastrointestinal function recovery and other physiological recovery indicators included postoperative complication rate,postoperative first exhaust or defecation time and postoperative hospitalization days.[Results]The nutrition index: the results showed that the 4th day after the operation of 3 groups of patients with serum total protein level differences(p<0.05),in ENN group the total protein level was 54.56 + 4.78g/L,TPF-D group total protein level of 54.88 + 4.74 g/L,were better than that in PPN group the total protein level of 50.97 + 5.12 g/L(p<0.05).The 10 th days after operation,TPF-D group BMI 25.06 + 3.06,better than that of PPN group 22.69 + 3.38(p<0.05);the total protein level of TPF-D group and ENN group were significantly lower than those in group PPN(p<0.01),and TPF-D group better than the result of ENN group(p<0.05);group TPF-D,prealbumin level and lymphocyte count better than group ENN(p<0.05),and ENN group better than the result of PPN group(p<0.05),and TPF group was significantly better than group PPN(p<0.01).The result of blood sugar index: The 1th day after operation,the blood sugar level of the 3 groups rose sharply,and there was no difference between the groups(p>0.05).Fourth days after operation,3 groups of patients with fasting and 2-hour postprandial blood glucose after breakfast and lunch were differences(p<0.05),the fasting blood glucose levels of TPF-D group and ENN group were all lower than that of group PPN(p<0.05),there was no difference between the TPF-D group and ENN group(p>0.05);after 4th day,2-hour postprandial blood glucose after breakfast of TPF-D group is better than the other two groups(p<0.05);2-hour postprandial blood glucose after lunch 0f the 4th days multiple analysis showed that TPF-D group is better than the PPN control group(p<0.05),but the TPF-D group and ENN group,ENN group and PPN group,there was no difference in blood glucose(p>0.05);2-hour postprandial blood glucose after dinner of the 4th days of TPF-D group better than group ENN(p<0.05).Tenth days after the operation of 3 groups of patients with blood glucose control exist significant differences between the groups(p<0.01),TPF-D group,fasting blood glucose control results better than the ENN group(p<0.05),which was significantly better than the PPN group(p<0.01);after tenth day of the 3 groups of patients' 2-hour postprandial blood glucose after breakfast compared with fasting glucose were the same,the difference is that the ENN group and the PPN groups had no difference(p>0.05);the 2-hour postprandial blood glucose after lunch and dinner on 10 th day were same.Immune and inflammatory indicators: first days after the operation,there was no difference in the inflammatory and immune indices between the 3 groups(p>0.05).On the fourth day after operation,there was a difference between the 3 groups in the CRP group(p<0.05),and the TPF-D group index was lower than that in the PPN group(p<0.05),but there was no difference between the TPF-D group and the other two groups(p>0.05).Tenth days after operation,TPF group of patients with WBC counts lower than PPN group(p<0.05);group TPF-D levels of CRP were lower than that of group PPN(p<0.05);after tenth days of Lymphocytes in patients with 3 groups of counts had significant differences(p<0.01),group TPF-D patients mean Lymphocyte count(1.70 + 0.70)*10^9/L,higher than that of ENN group lymphocyte count(1.34 + 0.43)*10^9/L(P<0.05),Lymphocyte count was significantly higher than that of PPN group(0.96 + 0.34)*10^9/L(p<0.01).The patients in group TPF-D were hospitalized 14.24 + 3.86 days after operation,shorter than group PPN(17.63 + 7.13 days)(p<0.05),and the first time after operation in group TPF-D was shorter than that in group PPN(p<0.05).The incidence of postoperative complications in group PPN was 3/19,group ENN was 3/20,group TPF-D was 1/21,complication rate of three groups was no different(p>0.05).[Conclusion] Enteral nutrition is better than the clinical effect of parenteral nutrition,and the application of enteral nutrition support in diabetes special enteral nutrition preparation has better clinical effect in recovery of nutrition,keep stable blood glucose control,reduce inflammation and immunity levels and the gastrointestinal function and other functional recovery after operation of gastric cancer.