Clinical Analysis Of Early Enteral Nutrition After Radical Gastrectomy

Objective:To investigate the results of early enteral nutrition after gastrectomy for postoperative nutritional status,rapid recovery of organ function,postoperative stress level and postoperative complications.Methods:From January 2017 to January 2019,60 patients who underwent radical resection of laparoscopic gastric cancer in the Department of Gastrointestinal Surgery,Second Affiliated Hospital of Kunming Medical University,were selected as subjects according to different nutritional support methods and enteral nutrition.These patients were randomized into an early enteral nutrition group(EEN group,n=20),a late enteral nutrition group(n=20),and a total gastrointestinal nutrition group(TPN group,n=20).Patients in the early enteral nutrition group received early enteral nutrition through the jejunal nutrition tube within 24 hours after surgery;the enteral nutrition was given on the 4th day after the operation in the late enteral nutrition group;the total parenteral nutrition group was deep in the 24 hours after surgery.Total parenteral nutrition was given to the venous access,and the nutritional support of the three groups was 7 days.All patients underwent venous blood test before,4 and 7 days after surgery:1.Nutritional indicators:total protein(TP),albumin(ALB)and prealbumin(PA);2.organ system damage indicators(liver function,bilirubin,creatinine,etc.);3.stress response(white blood cell and lymphocyte count,acute infection);4.record the patient's first exhaust time,total hospital stay and total hospitalization expenses;5.Record postoperative complications,fever time and antibiotic use.Results:1.The serum protein level can reflect the nutritional status of the body more intuitively.The nutritional status of the three groups was comparable.The EEN group had the best nutritional index on the 4th day after operation,and there were significant differences among the three groups(P<0.001).Early enteral nutrition support can improve the nutritional status of postoperative patients.2.The safety of the patients was judged from the liver and kidney function indexes.The liver and kidney function indexes of the three groups were equivalent(P>0.05).The liver and kidney function of the EEN group was better than the advanced enteral nutrition group at 4 and 7 days after operation.And the TPN group(P<0.05);the liver and kidney function of the postoperative enteral nutrition group and the total parenteral nutrition group were equivalent(P>0.05).It is suggested that early enteral nutrition has the same safety as conventional enteral nutrition and total parenteral nutrition.3.The postoperative PCT,IL-6 and CRP were higher than normal and the total lymphocytes decreased.The inflammatory stress index of EEN group was significantly lower than that of late enteral nutrition group on the 4th and 7th day after operation.In the TPN group(P<0.05),early enteral nutrition can reduce the stress response level of the body to a certain extent and promote postoperative recovery.4.There were different degrees of fever in all three groups.The duration of fever and antibiotic use time in EEN group and late enteral nutrition group were significantly shorter than those in TPN group(P<0.05).The duration of fever and antibiotic use time in EEN group also Significantly less than the late enteral nutrition group(P<0.05).The time to recovery of bowel function was significantly shorter in the EEN group than in the TPN group and the advanced enteral nutrition group(P<0.001),and hospitalization costs were lower(P<0.001).The length of hospital stay in the EEN group and the late enteral nutrition group was also significantly shorter than that in the TPN group(P<0.001),but there was no significant difference between the EEN group and the advanced enteral nutrition group(P>0.05).Conclusion:Early enteral nutrition after gastrectomy can significantly improve postoperative nutritional status;It promotes early recovery of tissues and organs;reduces stress levels,reduces the use of antibiotics,improves early prognosis;reduces the incidence of hospitalization complications,shortens hospital stay,and reduces total hospitalization costs.