早期肠内营养对老年原发性肝癌患者术后康复、生活质量及预后的影响

Influence of early enteral nutrition on postoperative rehabilitation, quality of life and prognosis in elderly patients with primary liver cancer

【摘要】目的 分析早期肠内营养(EN)对老年原发性肝癌(PLC)患者术后康复、生活质量及预后的影响。方法 采用随机数表法将武汉大学中南医院2019年6月至2022年6月收治的120例行肝部分切除术的老年PLC患者分为观察组(早期EN,n=60)及对照组(常规饮食干预,n=60)。比较两组患者术前、术后7d及14d的肝功能、免疫功能,统计其围术期相关指标；出院时采用肝胆肿瘤治疗功能评定量表(FACT-Hep)第四版评定患者生活质量,术后随访1年,统计患者预后。采用Cox风险比例回归模型分析影响患者预后的相关因素。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、χ²检验及方差分析。结果 术后7d,观察组白蛋白(ALB)水平高于对照组同时间点水平,差异均有统计学意义(均P<0.05)；术后14d,观察组患者胆碱酯酶(CHE)、ALB、CD4⁺细胞占比以及CD4⁺/CD8⁺比值均高于对照组,直接胆红素(DBIL)水平低于对照组,差异均有统计学意义(均P<0.05)。观察组术后肛门首次排气时间、拔除腹腔引流管时间以及出院时间均短于对照组,术后并发症发生率以及住院费用均低于对照组,观察组出院时生活质量量表各维度及总得分均低于对照组,差异均有统计学意义(均P<0.05)。Cox多因素分析提示,术后早期EN是其术后1年生存情况的保护因素(95%CI 0.144~0.793；P<0.05)。结论 早期EN治疗可促进老年PLC患者肝部分切除术后康复,提高其生活质量,且早期EN是影响患者术后1年预后的独立因素。

基金项目:国家自然科学基金(82003238)； 武汉市卫生健康委医学科研项目(WX21Q02)

【Abstract】Objective To analyze the influence of early enteral nutrition (EN) on postoperative rehabilitation, quality of life and prognosis in elderly patients with primary liver cancer (PLC). Methods A total of 120 elderly PLC patients who underwent partial hepatectomy in Zhongnan Hospital of Wuhan University from June 2019 to June 2022 were randomly divided into an observation group (early EN, n=60) and control group (routine dietary intervention, n=60) using the random number table method. The liver function and immune function of the two groups were compared before surgery, and at 7 and 14 days after surgery. The perioperative indicators were statistically analyzed. The quality of life of the two groups was assessed with the fourth edition of functional assessment of cancer therapy-hepatobiliary (FACT-Hep) at discharge. The patients were followed up for one year after surgery, and the prognosis of patients was statistically analyzed. Cox risk proportional regression model was employed to analyze the factors affecting the prognosis of patients. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test, χ² test or analysis of variance depending on data type. Results At 7 days after surgery, the albumin (ALB) level in the observation group was higher than that in the control group, and the differences were statistically significant (all P<0.05). At 14 days after surgery, the cholinesterase (CHE), ALB, CD4⁺cell ratio and CD4⁺/CD8⁺ ratio in the observation group were higher than those in the control group, the direct bilirubin (DBIL) level was lower than that in the control group, and the differences were statistically significant (P<0.05 for all). The time to the first postoperative flatus, abdominal drain removal time, and discharge time were shorter in the observation group than in the control group, the incidence of postoperative complications and hospitalization expenses were lower than those in the control group, and the scores of each dimension and total score of the quality of life in the observation group were lower than in the control group, and the differences were statistically significant (P<0.05 for all). Cox multivariate analysis suggested that early postoperative EN was a protective factor for one-year survival after surgery (95%CI 0.144-0.793; P<0.05). Conclusion Early EN therapy can promote the recovery in elderly PLC patients after partial hepatectomy and enhance their quality of life. Early EN is an independent factor affecting the prognosis of patients one year after surgery.

This work was supported by National Natural Science Foundation of China (82003238) and Medical Research Project of Wuhan HealthCommission (WX21Q02).