肺癌手術患者の管理における経腸栄養と組み合わせた加速リハビリテーション

Accelerated rehabilitation combined with enteral nutrition in the management of lung cancer surgery patients.

• Qin Ding
• Wei Chen
• Ying Gu
• Zhi-Yan Qi
• Yan-Hong Chen
• Jian Chen
• Lei Jiang

抄録

背景と目的:

外科的治療を受けた肺癌患者に対する経腸栄養と組み合わせた加速リハビリテーションの効果を検討する。

BACKGROUND AND OBJECTIVES: To investigate the effect of accelerated rehabilitation combined with enteral nutrition on surgically treated lung cancer patients.

方法と研究デザイン:

2017年1月から2018年1月までに当院で治療を受けた肺がん患者150例を対象にレトロスペクティブ解析を行った。患者66名を、従来の栄養を併用した対照群（Con群）と経腸栄養を併用した加速リハビリテーション群（EN群）に無作為に分けた。術後ドレナージ、総入院時間、総入院費、アルブミン、ヘモグロビン、総リンパ球数（TLC）を治療前後で比較した。

METHODS AND STUDY DESIGN: In total, 150 lung cancer patients treated in our hospital from January 2017 to January 2018 were retrospectively analysed. Sixty-six patients were randomly divided into a control group with conventional nutrition (Con group) and an accelerated rehabilitation combined with enteral nutrition group (EN group). Postoperative drainage; total hospitalization time; total hospitalization expenses; and albumin, haemoglobin and total lymphocyte counts (TLC) before and after treatment were compared.

結果:

血清アルブミン、プレアルブミン、ヘモグロビンは両群とも術後に減少し、EN群はCon群に比べて有意に高かった（p<0.05）。TLCは両群とも術後に減少し、EN群ではcon群よりも有意に高かった(p&lt;0.05)。術後ドレナージ量、総入院時間、総入院費はEN群の方がCon群より有意に低かった(p<0.05)。

RESULTS: The serum albumin, prealbumin and haemoglobin in both groups were decreased after operation and were significantly higher in the EN group (p<0.05) than in the Con group. The TLC decreased in both groups after operation and were significantly higher in the EN group than in the con group. The postoperative drainage volume, total hospitalization time and total hospitalization expenses were significantly lower in the EN group than in the Con group (p<0.05).

結論:

肺がん手術患者における経腸栄養と組み合わせた加速リハビリテーションの効果は明らかである。手術はストレスにつながり、異化を促進し、炭水化物、タンパク質、脂肪の合成を低下させ、患者の栄養リスクを増大させる。術前の栄養スクリーニングと評価を受けるリスクの高い肺がん患者のためのファストトラック低侵襲胸部手術と組み合わせた栄養サポートは、術後の合併症と入院時間を短縮し、栄養指標、免疫、呼吸機能の回復と臨床転帰を改善し、社会経済的利益につながることができます。

CONCLUSIONS: The effect of accelerated rehabilitation combined with enteral nutrition in lung cancer surgery patients is clear. Surgery leads to stress, which enhances catabolism and reduces the synthesis of carbohydrates, protein, and fat, increasing patients' nutritional risk. Nutritional support combined with fast-track minimally invasive thoracic surgery for at-risk lung cancer patients who undergo preoperative nutritional screening and assessment can reduce postoperative complications and hospitalization time and improve nutritional indicators, immunity, respiratory function recovery and clinical outcomes, leading to socioeconomic benefits.