The Investigation On The Application Of Home Enteral Nutrition Support In Patients With Postoperative Gastric Cancer

Background:Gastric cancer is one of the most common malignant tumors of the digestive system.Surgery is the preferred treatment for curing gastric cancer.Gastrointestinal reconstruction changes the physiological structure,affects the digestion and absorption of nutrients,and induces high incidence of malnutrition in postoperative patients,which is an important factor for the high incidence of complications and mortality.With the application of the Enhanced Recovery After Surgery(ERAS),the shortened postoperative hospital days directly lead to insufficient energy intake through oral administration when patients are discharged.It's more likely to cause nutritional complications when patients lack of knowledge,regarding nutritional support and nutritional tube care.Most guidelines recommend long-term home nutrition support for patients after gastric resection.However,the current development of HEN for patients with postoperative gastric cancer is still in the theoretical research level and has not been widely used in China.The existing problems of HEN patients after gastric resection are still unclear.Therefore,it is necessary to further clarify patients' situation and existing problems of HEN for gastric cancer,in order to providing reference for subsequent improvement of clinical practice.Objective:To describe the nutritional status and the application of home enteral nutrition support in patients with gastric cancer 4 weeks after discharge;And to identify the problems in home enteral nutrition support within 4 weeks after discharge.Methods:This study was a non-experimental observational study.Convenient sampling to enrolled 124 patients who were discharged 4 weeks after radical gastrectomy in a top-grade hospital in Beijing from September 2017 to January 2019.The patient's general demographic and disease characteristics were collected by using a self-designed questionnaire.At the same time,collected biochemical indicators such as body weight,BMI,Alb,HGB,LYM,PA and evaluated the nutritional status of patients with Patient-Generated Subjective Global Assessment(PG-SGA)at the time of discharge and 4 weeks later.Then investigated the patient's HEN condition and problems 4 weeks after patients' discharge by telephone follow-up using self-designed "Intestinal Nutrition Support Questionnaire".Results:(1)After 4 weeks of discharge,the body weight and BMI of patients were significantly lower than those at discharge moment(t=9.460,p<0.01;Z=-7.148;p<0.01).The counts of lymphocytes,hemoglobin and serum albumin levels were significantly increased after 4 weeks of discharge(Z=8.728,p<0.01;t=-4.195,p<0.01;t=-16.210,p<0.01).There was no significant difference in serum prealbumin between the time of discharge and 4 weeks later(t=1.350,p=0.180).Four weeks after patients'discharge,PG-SGA nutritional showed status was no significant difference than the time of discharge(?2=3.200,p=0.063).However,the incidence of severe malnutrition was 69.4%.(2)82.3%patients underwent HEN support within 4 the weeks after discharge,including 66.1%using ONS nutritional support,8.9%using TF support,and 7.3%selecting TF combined with ONS nutritional support,but only 66.1%patients insisted on HEN for 28 day.(3)The daily energy intake of patients with different nutritional support methods was significantly different(Z=33.88,p<0.01).TF combined with ONS was higher than TF patients,and the ONS was the lowest.(4)Poor taste of commercial enteral formulas,gastrointestinal intolerance,and complicated nutritional tube care were the main negative factors in HEN patient compliance.Conclusions:The patient's nutritional status was poor after 4 weeks of discharge,and the HEN utilization rate and compliance were not satisfied.The energy intake could not meet the patient's needs.Daily energy intake of HEN patients with ONS was lowest,but TF patients was higher than ONS patients,and TF combined with ONS treatment were the best.