The Research Of Early Enteral Nutrition Timing After Minimally Invasive Radical Resection Of Esophageal Carcinoma

Objective:The objective is to study and analyze the initiating enteral nutrition within 8~16 and24~48 hours after minimally invasive radical resection of esophageal carcinoma which could influence the nutritional status,intestinal flora,intestinal mucosal barrier and immune function of patients.And the aim is to seek for the best time of initiating enteral nutrition after minimally invasive esophageal carcinoma resection and assess its clinical value.Method:80 cases of patients who underwent minimally invasive esophageal carcinoma resection from June 2015 to December 2016 were were selected from the thoracic surgery department of Fu Zhou General Hospital of Nan Jing military command and divided into A group received enteral nutrition within 8~16 hours after surgery and B group received enteral nutrition within 24 ~ 48 hours after surgery according to random number table method.6 nutrient indexes and 10 immune indexes of pre-operation and the end of enteral nutrition intervention were collected and compared.4 intestinal mucosal barrier function indexes and 3 inflammatory indicators before and after the first day of operation and the end of enteral nutrition intervention were collected and the time of anal exsufflation,and the duration of hospitalization after operation and significant complications was observed and compared.We also scored the tolerance of enteral nutrition and compared the content of Lactic acid bacteria,Bacillus,Escherichia coli,Enterococcus and Strain Bacillus in feces tissues for the first time of defecation after operation.Thus,the nutrition status,immune function,intestinal mucosal barrier function and intestinal flora of two groups of patients were determined.Result:1.There was no statistical difference in weight,BMI,TSF,Alb,PA and TF of preoperation and the end of enteral nutrition intervention between two groups(P>0.05).In the end of enteral nutrition intervention,the Alb,PA and TF indexes of group A were higher than those of group B,which had statistical difference(P>0.05).2.There was no statistical difference in LYM,CD3+T cell,CD4+T cell,CD8+T cell,CD16+CD56+NK cell contents and Ig A,Ig G,Ig M,C3,C4 contents in peripheral blood of pre-operation between two groups(P>0.05).In the end of enteral nutrition intervention,the LYM,CD3+T cell,CD4+T cell,CD16+CD56+NK cell contents and Ig A,Ig G,Ig M,C3, C4 contents in peripheral blood of A were higher than those of group B,and the CD8+T cell index was lower than those of group B,which had statistical difference(P>0.05).3.There was no statistical difference in the I-FABP,ET,DAO and D-Lac contents in peripheral blood of pre-operation between two groups(P>0.05).On the first day after operation,the I-FABP,ET,DAO and D-Lac contents in peripheral blood were obviously higher than pre-operation,and those of group A were lower than those of group B,which had statistical difference(P<0.05).In the end of enteral nutrition intervention,the I-FABP,ET,DAO and D-Lac contents in peripheral blood were higher than those of pre-operation,but lower after the first day of operation,which had statistical difference(P<0.05);the IFABP and D-Lac contents of A were lower than group those of B,which had statistical difference(P<0.05),and there was no statistical difference of the ET and DAO contents between two groups(P>0.05).4.After the first defecation,Lactic acid bacteria and Bacillus in feces tissues of group A were significantly higher than those in group B;Escherichia coli,Enterococcus and Strain Bacillus were significantly lower than those in group B,and the difference was statistically significant(P<0.05).5.There was no statistical difference in CRP,PCT and WBC in peripheral blood before and after the first day of operation and the end of enteral nutrition intervention between two groups(P>0.05).6.The score of the tolerance of enteral nutrition of group A is higher than that of group B,so the difference has statistical significance.Compared the time of anal exsufflation between two groups,the result of group A was shorter than that of group B,which has statistical difference(P<0.001).There was no statistical difference of occurrence of serious complications and the duration of hospitalization after operation between two groups(P>0.05).Conclusion:Improvement effects of enteral nutrition for patients who tolerate the negative nitrogen balance within 8~16 hours after thoracoscopic resection of esophageal carcinoma,nutritional status,operative wound,intestinal mucosal barrier function,the balance of intestinal flora,gastro-intestinal function,nonspecific immunity,humoral immunity and cellular immune response are better than those of enteral nutrition 24~48 hours after surgery without increasing the occurrence of serious complications,inflammatory reaction and prolonging hospitalization time,but this nutritious time does not present the priority in the patients’ tolerance.