目的 探讨胃癌根治术后早期肠内营养不耐受的发生及相关影响因素。 方法 选取 2021 年 6 月至 2024 年 6 月于喀 什地区第一人民医院行腹腔镜根治术治疗的胃癌患者 260 例作为研究对象,根据术后早期行肠内营养有无出现喂养不耐受情 况分为耐受组(n = 188)和不耐受组(n = 72),对比两组包括性别、年龄、体质指数(BMI)、糖尿病史、高血压史、临床分期、肿瘤 直径、手术方式、手术时间、术中出血量、术后第 1 天下床活动时间、有无使用营养泵、肠内营养治疗途径、肠内营养治疗形式、 肠内营养开始时间、血清白蛋白、前白蛋白的基线资料。 采用单因素和多因素 Logistic 分析胃癌患者术后早期肠内营养不耐 受的危险因素,并基于多因素分析结果构建综合指数;采用受试者操作特征曲线( ROC 曲线)分析危险因素及综合指数预测 胃癌患者术后早期肠内营养不耐受的曲线下面积(AUC)、敏感度及特异度。 结果 不耐受组术后第 1 天下床活动时间≤4 h、 未使用营养泵、持续肠内营养治疗、术后 24 h 开始肠内营养及血清白蛋白≤35 g 患者的构成比均高于耐受组,前白蛋白水平 低于耐受组(P<0. 05)。 多因素 Logistic 回归分析显示,术后第 1 天下床活动时间≤4 h、未使用营养泵、持续肠内营养治疗、术 后 24 h 开始肠内营养、血清白蛋白≤35 g 是胃癌患者术后早期肠内营养不耐受的独立危险因素(P<0. 05)。 ROC 曲线分析显 示,综合指数预测胃癌患者术后早期肠内营养不耐受的 AUC 值、敏感度、特异度分别为 0. 769、0. 722、0. 750。 结论 术后第 1 天下床活动时间较短(≤4 h)、未使用营养泵、持续肠内营养治疗、术后过早开始肠内营养(24 h 内)以及血清白蛋白水平较 低(≤35 g)等因素均会对胃癌患者术后早期肠内营养不耐受产生不良影响,基于这些因素构建综合指数,可为预测术后早期 肠内营养不耐受风险提供参考,以便临床制订针对性干预措施,降低肠内营养不耐受发生率。

Objective To investigate the occurrence and related influencing factors of early enteral nutritional intolerance after radical gastrectomy for gastric cancer. Method A total of 260 patients with gastric cancer who underwent laparoscopic radical resection in the First People's Hospital of Kashgar Prefecture from June 2021 to June 2024 were selected as the research subjects. They were divided into the tolerance group n = 188 and the intolerance group n = 72 according to whether there was feeding intolerance in enteral nutrition in the early postoperative period. The baseline data of the two groups were compared. Univariate and multivariate Logistic analyses were used to analyze the risk factors influencing early postoperative enteral nutrition intolerance in patients with gastric cancer and a comprehensive index was constructed based on the results of multivariate analysis. The receiver operator characteristic curve ROC curve was used to analyze the area under the curve AUC sensitivity and specificity of risk factors and comprehensive indices in predicting early postoperative enteral nutrition intolerance in patients with gastric cancer. Result The proportions of getting out of bed for activity ≤4 hours on the first day after surgery no use of nutrition pumps continuous enteral nutrition support starting enteral nutrition 24 h after surgery and serum albumin ≤35 g in the intolerance group were all higher than those in the tolerance group while prealbumin was lower than that in the tolerance group P<0. 05 . Multivariate Logistic regression analysis showed that the time of getting out of bed on the 1st day after surgery ≤4 h no use of nutrition pump continuous enteral nutrition support enteral nutrition starting 24 h after surgery and serum albumin ≤35 g were independent risk factors for early postoperative enteral nutrition intolerance in patients with gastric cancer P<0. 05 . ROC curve analysis showed that the AUC value sensitivity and specificity of early postoperative enteral nutritional intolerance in gastric cancer patients predicted by composite index were 0. 769 0. 722 and 0. 750. Conclusion Short time of getting out of bed on the first day after surgery ≤4 h no use of nutrition pump continuous enteral nutrition support early start of enteral nutrition after surgery within 24 h and low serum albumin level ≤35 g are all factors that have adverse effects on early postoperative enteral nutrition intolerance in patients with gastric cancer. Based on these factors a comprehensive index was constructed. It can provide reference for predicting the risk of early postoperative enteral nutrition intolerance so as to formulate targeted intervention measures to reduce the incidence of enteral nutrition intolerance.