術前週邊靜脈營養可改善直腸癌病患術後營養狀況

Improving the Postoperative Nutritional Conditions in Patients with Rectal Cancer by Preoperative Peripheral Parenteral Nutrition

10.6320/FJM.2005.9(2).02

劉明宜(Ming-Yi Liu)；唐修治(Hsiu-Chih Tang)；楊仁成(Ing-Sing Yang)；楊慧蘭(Hui-Lan Yang)；陳肅霖(Su-Lin Chen)

靜脈營養 ； 術前營養支持 ； 營養不良 ； 腹部手術 ； 直腸癌 ； parenreral nutrition ； preoperative nutrition support ； malnutrition ； rectal cancer

台灣醫學

9卷2期（2005 / 03 / 01）

157 - 163

繁體中文

營養狀況常是影響接受腹部手術病人對手術耐受力以及手術效果的重要因素之一。一般對於術前營養不良的病患，常建議於術前先給予營養支持。但全靜脈營養支持(TPN)具有較高的風險與不便，而傳統的週邊營養(PPN)配方又不足以支持此類病人的營養需求，而至對此類病忠的術前營養支持頗受侷限。為探討手術前利用風險低且全營養配方的週邊營養支持法對直腸癌病患手術耐受力及預後的改善狀況，本研究採用回溯性病例對照研究法(Retrospective case control study)，針對25個有營養不良的直腸癌病人在手術前，給予改善配方的術前週邊靜脈營養支持，並與無法接受術前週邊靜脈營養支持的15個手術病人，比較手術後的預後狀況。結果顯示，手術前接受PPN營養支持的病患在術後血漿白蛋白濃度顯著高於未接受營養支持者；可下床活動天數及手術後住院天數，都顯著少於未接受營養支持者。此外，接受術前營養支持的病人術後沒有感染的現象，而未接受營養支持的病人則有26.7%感染或敗血症。研究同時發現術前PPN營養支持之期程平均5.6天即有顯著之改善效果，較之文獻指出的7至10天為短。此在縮短等候手術時間以減少病患不適、降低靜脈炎併發率、以及對病況緊急的病患尤具意義。

Malnutrition has been recognized a significant risk factor for the post-operated patients, especially for those malnourished patients undergone abdominal operations. In this study, retrospective case control method as used to investigate whether preoperative peripheral parenteral nutrition support would improve the postoperative nutritional conditions of rectal cancer patients. The results showed that the postoperative serum albumin of the 25 patients received preoperative nutrition support averaged 25.0±0.32g/dl, significantly better than those of the 15 ones not received the preoperative nutrition support. which averaged 1.92±0.42g/dl. The first ambulatory time required 3.0±0.8 days for the formers, significantly shorter than those for the latter ones, which averaged 4.9±2.4 days. Postoperative hospital days for the patients received preoperative peripheral nutrition support were 18.2±10.5 day, also significantly fewer than those without preoperative peripheral nutrition support, which averaged 33.7±20.0 day. More than 25% of the non-preoperative nutrition supported group as infected with sepsis, while none as infected in the preoperative nutrition supported ones. This study verified the importance of preoperative nutrition support for rectal cancer patients.