A Randomized Controlled Study Of Early Enteral Nutrition In Postoperative Rehabilitation Of Colorectal Cancer Patients

Objective:To study the clinical effect of early enteral nutrition in patients with colorectal cancer after operation.Methods:From December 2017 to October 2018,a total of 82 patients with colorectal cancer who were treated in the first department of general surgery,east hospital of Qingdao municipal hospital were included in the study.The patients were divided into early enteral nutrition group(EEN group)(n=40)and parenteral nutrition group(PN group)(n=42)using the random number table method.The experimental group: EEN group: The daily calories required by patients were calculated according to 125KJ/kg/d,choose TPFFOS [enteral nutrition mixed suspension(TPFFOS),ABBOTT LABORATORIES B.V.,Ross Product Manufacturer].The energy density is 1 kcal/mL.In the first postoperative day after morning rises try to drink at a comfortable temperature of 40 ~ 80 mL warm water,without gastrointestinal reactions such as nausea,vomiting,after 2 h to give enteral nutrition preparations,dosage of 30 ~ 50 mL,for the first time once every 2 ~ 3 h,the amount of 50 ~ 100 mL,total amount is less than 600 mL.Enteral nutrition preparation was continued on the second day after surgery,with the dosage of 100 ~ 150 mL each time and once every 3 ~ 4 hours.According to the patient’s tolerance,other liquid diets,such as rice soup,juice and noodle soup,were given,but soy milk and milk were forbidden.On the third day after surgery,60 ~ 100 mL/ time of enteral nutrition was given,once every 3 ~ 4 hours.Patients were given semi-liquid food,such as noodles,rice porridge,egg custard and stews.On the 4th day after surgery,if the patient can tolerate it,the transition to normal diet can be made,but the principle of eating less and more meals should be followed.If the patient cannot tolerate it,the appropriate dosage should be increased on the 3rd day and the normal diet should be restored as soon as possible.In the EEN group,in addition to the calories supplied by enteral nutrition,the remainder was supplemented by parenteral nutrition.Control group: PN group,parenteral nutrition was given on the first day after surgery,calories: 125KJ/kg/d,sugar to fat ratio: 6:4;Nitrogen content: 0.15-0.2g/kg/d,hot-nitrogen ratio: 150kCal/1g;The electrolytes and insulin were supplemented as usual,and vitamins and trace elements were supplemented.The same oral nutrient solution should be given to patients after exhaust.Observation index: nutritional index evaluation: patients were evaluated according to their transferrin value(TF),serum albumin value(ALB)and prealbumin value(PA)before and on the first day,the third day and the fifth day after surgery.Evaluation of clinical indicators: patients’ weight loss and hospitalization costs were assessed.Rehabilitation assessment: the rehabilitation status was evaluated according to the patient’s postoperative exhaust time,bed time and hospitalization time.Evaluation of immune indexes: IgG,IgA,IgM,C3 and C4 were detected by automatic protein analyzer,and CD3+,CD4+,CD8+ and CD4+/CD8+ were detected by cytometry.IgG,IgA and IgM belong to the immunoglobulin,C3 and C4 belong to the complement level,and CD3+,CD4+,CD8+ and CD4+/CD8+ belong to the t-cell subgroup.Results:There were no significant differences between the two groups in preoperative transferrin value(TF),serum albumin value(ALB),and preoperative albumin value(PA).On the first day,the third day,and the fifth day after surgery,the values of transferrin(TF)in the EEN group were 1.81 ±0.72,1.83 ±0.73,and 1.85± 0.76.Serum albumin values(ALB)on the first,third and fifth days after surgery were 39.41 ±2.75,40.02 ±2.76 and 40.11 ±2.84.On the first day,the third day and the fifth day after surgery,the albumin value(ALB)of 284.15 ±16.14,285.22± 17.02 and 286.31 ±17.11 were better than those of the PN group,and the difference was statistically significant(P < 0.05).EEN weight loss: 3.61± 0.54 kg in the experimental group and 3.86± 0.42 kg in the control group,the difference was statistically significant(P < 0.05).Hospitalization costs: 50863.23 ±1365.25 yuan in the experimental group and 62354.54 ±1685.63 yuan in the control group,the difference was statistically significant(P < 0.05).All the immune indexes of EEN group were better than those of PN group,and the difference was statistically significant(P < 0.05).The exhaust time,bed time and hospitalization time of EEN group were all better than that of PN group,and the difference was statistically significant(P < 0.05).Complications such as abdominal distension,hyperglycemia,incision infection and pulmonary infection were significantly less in the EEN group than in the PN group,with statistically significant differences(P < 0.05).Conclusion:Colon cancer patients after surgical treatment of the clinical effect of early enteral nutrition,can improve recovery,but also improve nutrition indicators,worthy of reference,and after implementation can reduce complications,shorten hospitalization time and remove the time,reduce the cost of treatment,improve the body’s immune function,thus confirm the method of clinical value.However,few data samples were selected in this study,and the postoperative quality of life of the patients was not studied.In the later study,the study samples should be enlarged to evaluate the value of early enteral nutrition treatment for postoperative patients in improving their quality of life,so as to improve the overall rehabilitation effect of the patients.