| 摘要: |
| 目的：分析早期间断肠内营养在晚期胃癌非治愈性手术患者中的应用价值及对应激性血糖波动、心率变异性的影响。方法：回顾收集2022年1月至2024年10月我院收治的晚期胃癌非治愈性手术患者106例,根据术后不同喂养方式分为持续组(给予早期持续肠内营养,n=57)与间断组(给予早期间断肠内营养,n=49),比较两组的围术期指标(首次排气时间、恢复正常饮食时间、住院时间、7d热卡达标率)、治疗前及治疗7d后的营养指标[血清前白蛋白(PA)、白蛋白(ALB)、血红蛋白(Hb)]、治疗7d内的血糖波动[平均血糖波动幅度(MAGE)、血糖不稳定指数(GLI)]、心率变异性指标[5分钟相邻R波间距标准差均值(SD)、连续相邻R波间距差异平方根(SSD)、相邻R波间距相差>50毫秒比例(PNN50)]。结果：间断组的首次排气时间、恢复正常饮食时间、住院时间均低于持续组,而7d热卡达标率高于持续组,差异具有统计学意义(P＜0.05)。治疗前,两组的PA、ALB、Hb水平差异无统计学意义(P＞0.05),治疗后,两组的PA、ALB、Hb水平均升高,且间断组的高于持续组,差异具有统计学意义(P＜0.05)。间断组的MAGE、GLI均低于持续组,差异具有统计学意义(P＜0.05)。重复测量方差分析显示,组内比较：和治疗前相比,两组在治疗1d后、治疗3d后、治疗7d后的SD、RMSSD、PNN50均升高,差异具有统计学意义(P＜0.05)；组间比较：间断组在治疗1d后、治疗3d后、治疗7d后的SD、RMSSD、PNN50高于持续组,差异具有统计学意义(P＜0.05)。SD、RMSSD、PNN50在时间和组别上存在交互效应,差异具有统计学意义(P＜0.05)。结论：与早期持续肠内营养相比,早期间断肠内营养能缩短患者首次排气、恢复正常饮食及住院时间,提高 7 天热卡达标率。可更有效地提升患者营养指标,降低应激性血糖波动,改善心率变异性。 |
| 关键词: 早期间断肠内营养 晚期胃癌 非治愈性手术 血糖波动 心率变异性 |
| DOI： |
| 分类号:R459.3 |
| 基金项目:浙江省医药卫生科技计划项目（计划编号:2023KY1355） |
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| The application value of early intermittent enteral nutrition in patients with advanced gastric cancer undergoing non curative surgery and its impact on stress-induced blood glucose fluctuations and heart rate variability |
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HeYi, LanHui, ZhuJingjing
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Lishui Municipal Central Hospital
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| Abstract: |
| Objective: To analyze the application value of early intermittent enteral nutrition in patients with advanced gastric cancer undergoing non curative surgery and its impact on stress blood glucose fluctuations and heart rate variability. Methods: A total of 106 patients with advanced gastric cancer who underwent non curative surgery in our hospital from January 2022 to October 2024 were retrospectively collected. They were divided into a continuous group (receiving early continuous enteral nutrition, n=57) and an intermittent group (receiving early intermittent enteral nutrition, n=49) according to different feeding methods after surgery. The perioperative indicators (first exhaust time, time to return to normal diet, length of hospital stay, 7-day hot card compliance rate), nutritional indicators before and after treatment [serum prealbumin (PA), albumin (ALB), hemoglobin (Hb)], blood glucose fluctuations within 7 days of treatment [mean blood glucose fluctuation amplitude (MAGE), blood glucose instability index (GLI)]were compared between the two groups. Heart rate variability index [5-minute mean standard deviation (SD) of adjacent R-wave spacing, square root difference (SSD) of continuous adjacent R-wave spacing The ratio of the distance difference between adjacent R waves being greater than 50 milliseconds (PNN50)]. Results: The first exhaust time, time to return to normal diet, and hospitalization time of the intermittent group were all lower than those of the continuous group, while the 7-day hot card compliance rate was higher than that of the continuous group, and the difference was statistically significant (P<0.05). Before treatment, there was no statistically significant difference in the levels of PA, ALB, and Hb between the two groups (P>0.05). After treatment, the levels of PA, ALB, and Hb in both groups increased, and those in the intermittent group were higher than those in the continuous group, with a statistically significant difference (P<0.05). The MAGE and GLI of the intermittent group were lower than those of the continuous group, and the difference was statistically significant (P<0.05). Repeated measures ANOVA showed that within group comparison: compared with before treatment, SD, RMSSD, and PNN50 increased in both groups after 1 day of treatment, 3 days of treatment, and 7 days of treatment, and the differences were statistically significant (P<0.05); Inter group comparison: The SD, RMSSD, and PNN50 of the intermittent group were higher than those of the continuous group after 1 day, 3 days, and 7 days of treatment, and the differences were statistically significant (P<0.05). SD, RMSSD, and PNN50 exhibit interactive effects in terms of time and group, with statistically significant differences (P<0.05). Conclusion: Compared with early continuous enteral nutrition, early intermittent enteral nutrition can shorten the patient"s first bowel movement, restore normal diet and hospitalization time, and improve the 7-day calorie compliance rate. It can effectively improve patients" nutritional indicators, reduce stress-induced blood glucose fluctuations, and improve heart rate variability. |
| Key words: Early intermittent enteral nutrition Advanced gastric cancer Non curative surgery Blood glucose fluctuations Heart rate variability |