观察联合营养支持疗法对轻中度营养不良食管癌患者围手术期营养改善的效果。

运用患者总体主观评分法(PG-SGA)筛选轻、中度营养不良食管癌患者172例，并采用随机数字法分成观察组和对照组，每组86例。观察组术前3 d进行肠内营养治疗，术后第1天给予肠内外营养支持治疗；对照组术后第3天给予肠内营养治疗。比较两组患者的围手术期营养状态(术后第7天)、胃肠功能、并发症发生情况及患者满意度。

术后第7 d，观察组血清前白蛋白和白蛋白水平分别为(34.33±3.32)g/L和(33.68±4.12)g/L，显著高于对照组的(31.23±3.41)g/L和(31.32±3.37)g/L，差异有统计学意义(P<0.05)；观察组肠鸣音恢复时间和肛门排气时间分别为(61.53±6.37)h和(66.69±9.47)h，显著短于对照组的(82.31±8.24)h)和(113.24±12.38)h，差异有统计学意义(P<0.01)；观察组和对照组术后并发症发生率比较的差异无统计学意义(8.14% vs 9.30%，P>0.05);观察组术后患者满意度优秀率为89.53%，显著高于对照组的61.63%，差异有统计学意义(P<0.01)。

术前营养干预联合术后早期肠内外营养支持治疗，能显著改善食管癌患者围手术期的营养状态，促进胃肠道功能恢复，提高患者满意度。

To explore the effect of combined nutritional support therapy on nutritional improvement in esophageal cancer patients with mild to moderate malnutrition.

A total of 172 cases of esophageal cancer patients with mild to moderate malnutrition from August 2017 to May 2018 in our hospital were screened by Patient-Generated Subjective Global Assessment(PG-SGA) and divided into two groups with 86 cases in each group by random number method. Patients in both groups were given preoperative dietary guidance, postoperative fasting and parenteral nutrition treatment. The control group started enteral nutrition treatment on the third day. The observation group received enteral nutrition treatment 3 days before surgery and enteral and parenteral nutrition support treatment on the first day after surgery. On the 7th day after operation, gastrointestinal function recovery, nutritional status, complications and patient satisfaction were compared between the two groups.

On the seventh postoperative day, the levels of prealbumin[(34.33±3.32)g/L] and albumin[(33.68±4.12)g/L] in the observation group were higher than those in the control group [prealbumin of (31.23±3.41)g/L and albumin of (31.32±3.37)g/L], and the difference was statistically significant (P<0.05). The recovery time of bowel sounds[(61.53±6.37)h] and anal exhaust time[(66.69±9.47)h] in observation group were better than those in the control group[ recovery time of bowel sounds of (82.31±8.24)h and exhaust time of (13.24±12.38)h, and the difference was statistically significant(P<0.01). The incidence of postoperative complications was 8.14% in the control group and 9.30% in the observation group, with no statistically significant difference(P>0.05). The postoperative satisfaction rate of patients in the observation group was 89.53%, which was significantly higher than that of the control group (61.63%), and the difference was statistically significant (P< 0.01).

Preoperative nutrition intervention combined with early postoperative enteral and parenteral nutritional support therapy can improve the nutritional status of patients, promote the recovery of gastrointestinal function, and improve patient satisfaction.