改良式批式空腸灌食法在食道癌切除術後早期之成效

Effectiveness of Early Modified Bolus Jejunostomy Feeding in Esophageal Cancer Patients Receiving Esophagectomy

背景：食道癌病患術後初期無法由口進食，必須盡早供給腸道灌食維持營養，建立與提供適當的空腸灌食方案是重要的。目的：建立食道癌病人的改良式空腸灌食方案，並比較改良式和傳統法之成效差異。方法：本研究為措施成效研究，採回溯性病歷回顧收集資料，成效包括空腸灌食相關腸道症狀（出院時和出院後一個月）、術後住院日數、身體質量指數下降百分比（出院時和住院時比較、以及出院後一個月和住院時比較）、白蛋白指數（出院時和出院後一個月）以及30天內再入急診率。結果：共103位參與此研究，傳統組42位，改良組61位。出院時，兩組在空腸灌食相關腸道症狀、白蛋白指數沒有顯著差異，但在術後住院日數以及身體質量指數下降程度，改良組明顯少於傳統組（t＝-2.23，p＝.03；χ2＝12.2，p＝.01）。出院後一個月，兩組在白蛋白指數及30天內再住急診率沒有顯著差異，但在空腸灌食相關腸道症狀、身體質量指數下降程度改良組明顯少於傳統組（χ2＝37.2，p＝.01；χ2＝8.53，p＝＜.00）。結論：本研究建立的改良式空腸灌食流程，可提供病患術後早期營養，降低術後體重下降程度，減少術後住院日數，相較於傳統持續性灌食，並不會增加腸道症狀，建議提供給食道癌術後初期空腸灌食及居家灌食參考。

Background: During the early nil-by-mouth period, , it is essential to maintain nutrition by providing enteral feeding as soon as possible for postoperative esophageal cancer patients. As a result, a proper jejunostomy feeding protocol is vital. Purpose: To establish a modified jejunostomy feeding measure for postoperative esophageal cancer patients and compare the effectiveness between the traditional and modified methods. Method: This study was an intervention research. Data were collected by retrospective chart review. The effectiveness indicators included JF related gastrointestinal (GI) symptoms (at discharge and one month after discharge), postoperative hospital stay, decreasing percentage of Body Mass Index (comparison between hospitalization and discharge, and comparison between hospitalization and one month after discharge), albumin index (at discharge and one month after discharge), and the rate of readmission to the emergency department in 30 days after discharge. Result: There were 103 patients enrolled in this study, 42 in the traditional feeding group and 61 in the modified feeding group. At discharge, there were no significant differences between the two groups in JF-related GI symptoms and albumin index, but the postoperative hospital stays and decreasing percentage of Body Mass Index in the modified group was significantly lower than the traditional group (t=-2.23, p=.03; χ2=12.2, p=.01). One month after discharge, there were no significant differences in the albumin index and the rate of readmission to emergency room in 30 days between the two groups. The JF-related GI symptoms and decreasing percentage of Body Mass Index was significantly lower in the modified feeding group (χ2=37.2, p=.01; χ2=8.53, p=<.00). Conclusion/Practical Application: The modified feeding procedure established by this study provides patients with sufficient nutrition in early postoperative period, reduces the degree of weight loss after surgery, and shortens the hospital stays postoperatively. Comparing to the traditional approach, the modified feeding does not increase JF related GI symptom. The modified feeding procedure is recommended to postoperative esophageal cancer patients for early JF and home feeding.