喉頭癌患者に術後経腸栄養支援看護と早期経口栄養を併用した場合の術後効果と咽頭瘻治癒の解析

Analysis of post-operative efficacy and pharyngeal fistula healing in patients with laryngeal cancer treated with post-operative enteral nutrition support nursing combined with early oral feeding.

• Aitao Lin
• Jin Ye
• Zhiyuan Wang
• Pei Li

抄録

本研究は，喉頭癌（LC）患者における術後経腸栄養支援看護と早期経口栄養補給を併用した場合の術後効果と咽頭瘻（PF）治癒への影響を解析することを目的とした。2014 年 5 月～2016 年 9 月に喉頭切除術を受けた LC 患者 133 例を対象に，レトロスペクティブ解析を行った．このうち、経腸栄養支援看護と経鼻胃栄養を併用した患者61例（対照群）と、経腸栄養支援看護と早期経口栄養を併用した患者72例（観察群）を対象とした。血清アルブミン（ALB）、プレアルブミン（PA）、ヘモグロビン（Hb）、リンパ球数（LYM）を術前と術後（術後7日目と14日目）で比較した。また、術後体重、上腕筋周長（UAMC）、上腕三頭筋皮膚彎曲（TSF）、術後感染症、副作用、PF治癒率を測定した。手術前の対照群と観察群の間には差は認められなかった（いずれもP>0.05）。ALB、Hb、PA、LYMは術後7日目と14日目に対照群で観察群と比較して有意に低下した(すべてP<0.05)。対照群では治療中にPFを発症した患者は5例、観察群では術後にPFを発症した患者は7例であった。PFの平均治癒時間、術後感染症患者数、副作用には両群間で差は認められなかった（いずれもP>0.05）。術後14日目の観察群の体重、UAMCは、同一患者と対照群では手術前と比較して有意に高かった（いずれもP<0.05）が、TSFには差は認められなかった（P>0.05）。体重、UAMC、TSFについては、対照群では手術前と術後14日目で差は認められなかった（いずれもP>0.05）。このように，術後経腸栄養支援看護と早期経口栄養を併用することで，LC患者の術後効果は有意に改善し，PF治癒には影響を及ぼさなかった。

The present study aimed to analyze the effects of post-operative enteral nutrition support nursing combined with early oral feeding on post-operative efficacy and pharyngeal fistula (PF) healing in patients with laryngeal cancer (LC). A retrospective analysis of 133 patients with LC, who underwent laryngectomy between May 2014 and September 2016, was conducted. Of these patients, 61 patients (control group) were treated with enteral nutrition support nursing combined with nasogastric feeding, and 72 patients (observation group) were treated with enteral nutrition support nursing combined with early oral feeding. Levels of serum albumin (ALB), pre-albumin (PA), hemoglobin (Hb) and the lymphocyte count (LYM) were compared before and after surgery (7 and 14th post-operative days). The post-operative weight, upper arm muscle circumference (UAMC), triceps skinfold (TSF), post-operative infection, adverse reactions and PF healing were also measured. No differences were observed between the control and observation groups before surgery (all P>0.05). ALB, Hb, PA and LYM were significantly decreased in the control group on the 7 and 14th days post-operatively compared with those in the observation group (all P<0.05). Five patients in the control group presented with PF during treatment, and seven patients in the observation group suffered from PF after surgery. No difference in the average healing time of PF, number of patients with post-operative infection and adverse reactions were observed between the two groups (all P>0.05). The weight and UAMC in the observation group, 14 days post-operatively, were significantly higher than those before surgery in the same patients and in the control group (all P<0.05), whereas no difference in TSF (P>0.05) was observed. No differences in weight, UAMC and TSF were revealed in the control group before surgery and on the 14th day post-operatively (all P>0.05). Thus, post-operative enteral nutrition support nursing combined with early oral feeding resulted in significant improvement in the post-operative efficacy of patients with LC and had no effect on PF healing.

Copyright: © Lin et al.