Effects Of Postoperative Enteral High-protein Nutrition On Postoperative Recovery In Patients With Esophageal Cancer

Objective:Surgery is the first choice for radical treatment of esophageal cancer.Most patients with esophageal cancer have malnutrition,and the esophagectomy and reconstructive surgery are more traumatic,with more postoperative complications and aggravation of malnutrition.Postoperative protein support therapy is the key to improve malnutrition.The current guidelines recommend a dose of 1.2 to 2.0g/kg/d for tumor protein.This study investigated the feasibility of high intestinal protein(2.0 to 3.0g/kg/d)in the treatment of postoperative patients with esophageal cancer,and elucidated the safety of high protein supplements and its impact on postoperative rehabilitation of patients with esophageal cancer.Methods:The data were collected from October 1,2016 to December 31,2018 in thoracic surgery.According to the clinical route of diagnosis and treatment of esophageal cancer in China,preoperative routine examination was carried out.The patients were in accordance with the indications of operation and were over 18 years old,and were pathologically proved to be esophageal adenocarcinoma or squamous cell carcinoma,TNM stage I to ?,60 patients volunteered to participate in this study.They were randomly divided into experimental group(n=27)and control group(n=33).All patients were evaluated for nutrition screening upon admission,and the patients who met the indications for surgery were treated with "three incisions and two incisions",including thoracoscopic and laparoscopic minimally invasive operations,and jejunostomy was performed intraoperatively to indwelling enteral nutrition tube.After the recovery of postoperative bowel sounds,patients in the control group were given homogenate through jejunal nutrition tube,while patients in the experimental group were given high-protein powder + homogenate.The average protein support in the control group was about 1.4g/kg/d on the 5th day after surgery,and 1.7g/kg/d on the 7th day after surgery.The average amount of protein support in the experimental group was about 2.0g/kg/d on the 5th day after surgery,and 2.4g/kg/d on the 7th day after surgery.Patients in both groups were treated with intravenous nutrition.Keep detailed records of patients(1)preoperative general information: age,gender,surgical method,postoperative pathological stage,pathological type,blood picture,biochemistry,blood ammonia,etc.;(2)preoperative nutrition risk screening and assessment: nutrition risk screening table 2002(NRS 2002),body weight,body mass index(BMI);(3)operation time and blood loss;(4)postoperative protein grams were given to the experimental group and the control group every day;(5)blood biochemical results on the first,third,fifth and seventh days after surgery,postoperative hospitalization time,postoperative time of thoracic drainage tube extraction,postoperative chest radiographs,complications during hospitalization(infectious complications and non-infectious complications),and common side effects of enteral nutrition.SPSS 22.0 software was used for statistical analysis.Measurement data conforming to the normal distribution were expressed as((?)±s),Independent t test was used for inter-group comparison and paired t test was used for intra-group comparison.Measurement data not conforming to the normal distribution was used as rank sum test,and count data was used as chi-square test.Results:1.There was no significant difference in general data between the experimental group and the control group(P>0.05).2.There was no significant difference in preoperative nutrition screening assessment,body weight and BMI between the experimental group and the control group(P>0.05).3.There was no statistically significant difference in operation time between the experimental group and the control group(P>0.05);There was no significant difference in intraoperative blood loss between the experimental group and the control group(P>0.05).4.The serum albumin values of the experimental group and the control group on the 1st,3rd,5th and 7th days after surgery were all lower than those before surgery,with statistical significance(P < 0.05).5.There was no significant difference in serum albumin between the experimental group and the control group on the 1st and 3rd day after surgery(P > 0.05).The serum albumin level of the experimental group was higher than that of the control group on the 5th and 7th day after surgery,with statistical difference(P<0.05).6.There was no significant difference in liver and kidney function and blood ammonia between the experimental group and the control group on the first,third,fifth and seventh days after surgery(P>0.05).There was no statistically significant difference between the experimental group and the control group in the duration of thoracic drainage tube extraction and hospitalization after surgery(P>0.05).There was no statistical difference in the incidence of postoperative pneumonia between the experimental group and the control group(P>0.05).There was no significant difference in side effects related to abdominal distension,diarrhea,abdominal pain,nausea and vomiting between the experimental group and the control group after enteral nutrition(P>0.05).Conclusion:1.Postoperative administration of high protein(2.0 to 3.0g/kg/d)in patients with esophageal cancer is safe and feasible;2.High protein transintestinal administration can help maintain the postoperative plasma protein content of patients with esophageal cancer,reduce inflammatory reaction and length of hospital stay,and promote the rapid postoperative recovery of patients with esophageal cancer.