Esophageal cancer patients after surgery on enteral nutrition (EN) support and care

[Abstract] Perioperative nutritional support in patients, especially esophageal cancer surgery is more important, malnutrition, many see in cancer patients, their severity is directly related to life and the lives of patients for long-term treatment of cancer patients with chemotherapy, radiotherapy After varying degrees of prevalence of protein, energy, and various trace elements such as the lack of immunity for the body to restore very negative, so nutritional support after esophageal cancer patients has attracted much attention. enteral nutrition (EN is necessary . can improve the body resistance of patients to reduce complications and reduce mortality, improve patient quality of life is essential to slow down life through reasonable care and good nutritional support, so that patients can recover soon.

[Keywords] esophageal cancer, enteral nutrition, care
[Abstract] Perioperative nutritional support in patients, especially esophageal cancer surgery is more important, malnutrition, many see in cancer patients, their severity is directly related to life and the lives of patients. Long-term treatment for cancer patients with chemotherapy, radiotherapy prevalence varying degrees of protein, energy, and various trace elements such as the lack of immunity. Very bad for the body recovery. Therefore, nutritional support after esophageal cancer patients has attracted much attention. Early enteral nutrition (EN) is necessary. Can improve the body resistance of patients to reduce complications and reduce mortality and improve quality of life in patients with slow life is very necessary. Nutritional support through a reasonable and good care, so patients can recover soon.

[Keywords:] Esophageal cancer, Enteral nutrition, Care

1 Clinical data
The group selected May 2009-2011 resection of esophageal cancer patients received 30 patients, 28 males, 2 females, aged 45-78 years old, and placing a nasogastric tube or nose 10 to 15 days or more bowel (2 patients because of postoperative chest tube drain port with up to one year), of which 28 patients by continuous infusion of nutrient solution 2 weeks after extubation have oral intake, 2 patients given parenteral nutrition and enteral nutrition therapy After two courses of the transition to the phasing out of Parenteral Enteral Nutrition. were given peptide-based nutrition one hundred common factors plus glutamyl particles, good memory, and homemade beef stew protein mixture of slow infusion of potassium ions, while providing high-quality Note excellent yogurt pushing through long-term nutritional support in patients with leak port discharged two patients have been healed by 30 patients on enteral nutrition support, so essential to maintain the nutritional status of patients in positive nitrogen balance, significantly improved a variety of nutritional immunity index remained at normal levels.

2 Care
2.1 Psychological Care: esophageal cancer patients with depression, despair, after the home have a variety of nose and intestinal discomfort, hunger and so on.

Preach the importance of implementation of enteral nutrition and methods of use and attention, this discomfort may be many, since the patients do not intent to use and even against the emotional, some patients the effect of enteral nutrition skeptical, so We have to communicate with patients, do explanatory work, make positive and effective enteral nutrition should be sent to the patient.

2.2 nasogastric tube care and nasal enteral nutrition: (1 proper care and feeding tube, to prevent slippage movement, coiled twisted, leaving room for a fixed time, to avoid accidentally activities prolapse (2 or interrupt daily infusion before and after infusion , have 20ml syringe, 20ml warm water rinse extraction pipe, to prevent the residual nutrient solution.

2.3 Complications of enteral nutrition and nursing care observed: (1) feeding the jejunum, the patient can not tolerate, there may be abdominal distention, abdominal pain, nausea; serious when vomiting, diarrhea, hyperactive bowel sounds. During the intestinal nutrition the day before, while intestinal type isotonic saline 200ml, a process of adaptation to the gut, and observe the abdomen, such as no abdominal pain, abdominal distension, give the above EN. (2 nutrient solution concentration should follow from low to high concentration gradually increased until it reaches the desired concentration, speed of start is generally 25-50ml / h, after every 12-24h increased 25ml, available by adding hot water bottle hot water bottle or liquid deposited in the infusion tube, can play a role in regulating the temperature (3, with good or complete nutrient solution with 4 ℃ refrigerator should be placed in the preservation, shelf life of not more than 24h.

Links to free download http://www.hi138.com 2.4 and biochemical indicators of nutrition indicators observed: Record number of days patients with EN, the incidence of complications, enteral nutrition on metabolism in less interference, metabolic complications occur less the chance, but also requires careful observation (1 patient after the detection of EN support the concentration of serum protein, liver function and changes in enzymes. regular blood glucose, urea nitrogen, creatinine, plasma , the determination of prothrombin and other timely observation without gastrointestinal bleeding, diarrhea, vomiting, abdominal distension and obstruction, etc. The patient should be a comprehensive assessment of nutritional status (2 based on the patient's nutritional status to determine the amount of its supply of nutrients , long-term enteral nutrition in patients prone to lack of micro-elements, such as Zn, Cu, Fe2, VitB12, folic acid should be added.

3 Discussion
Some studies have shown [3]: If the normal intestinal function before surgery, after the absorption of its activities and there has been, after the paralysis is limited to the stomach and colon, stomach paralysis 12 days, the colon paralysis 35 days as long as the full decompression of the stomach, surgery and even a few hours after the first day for enteral feeding. postoperative enteral feeding started earlier on the restoration of anabolic sooner. esophageal cancer patients present gastric retention, too little stomach acid, fatty diarrhea or diarrhea, early satiety , reflux Early enteral nutrition and probiotic yogurt to prevent intestinal atrophy, when the prevention of traumatic stress are prone to translocation of intestinal flora, reduce diarrhea, reduce infection rates, but also to promote muscle recovery after surgery, help speed the healing of the anastomosis, to promote faster and visceral protein synthesis. [4] EN helps to maintain cell structure and function of intestinal integrity, reducing the release of endotoxin and bacterial translocation, stimulate gastrointestinal hormone secretion, and promote the stomach motility and cholecystokinin, recovery of gastrointestinal function, inhibition of metabolic hormones, reduce intestinal high metabolic reactions, to correct intestinal ischemia, increased visceral blood flow, nutritional support is better than the PN, with few complications and low cost. Clinical common uniform of the slow 24-hour continuous infusion method, to reduce intestinal complications. Tube nutrition suspension for a long time, increasing the opportunity for contamination, perishable, etc. Therefore, the observation and timely care, good job, "three examinations of the seven "working through of 30 patients had a series of cases of early treatment and care of its implementation of enteral nutrition therapy, and achieved satisfactory results.

References
[1] Wu Zhaoguang. Zhaohan. Wuguo Hao. Jin Dayong Practical clinical nutrition therapy, nutritional treatment of cancer patients, Shanghai Science and Technology Press, 2001,10, (1) 320-321
[2] Li Ying and other chronic liver disease, nutritional support Chinese Journal of Clinical Nutrition 2001,6, 19135-136
[3] Nachlas MM. Gastrointestinal Motility studies as aguide to postoperative management. Ann surg, 1972,175 (2); 501
[4] Chen Qing, etc. .. mucosal barrier theory of clinical nutrition, basic theory and function. Xinjiang People's Health Publishing House .65-67 Links to free download http://www.hi138.com