全胃切除术后辅助化疗期间强化肠内营养对机体营养状况及免疫功能的影响  

Evaluation of glutamine-enhanced enteral nutritional support during postoperative chemotherapy after radical total gastrectomy

作　　者：黄棉生[1] 庄业忠[1] 林佳锐[1] 李镠洋[1] 翁桢泓[1] 王伟峰[1] 

机构地区：[1]汕头大学医学院附属肿瘤医院腹部外科,汕头515031

出　　处：《消化肿瘤杂志（电子版）》2013年第3期180-183,共4页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的探讨全胃切除术后辅助化疗期间加强肠内营养治疗的意义。方法 2011年10月至2013年3月在我院腹部外科行根治性全胃切除的70例进展期胃癌及食管-胃结合部癌患者,随机分为试验组和对照组各35例。辅助化疗期间试验组给予每日添加谷氨酰胺和精氨酸的整蛋白型营养粉安素予营养支持,对照组未给予积极营养干预。采用患者整体主观评分法(PG-SGA)评价患者营养状况,比较两组患者整体营养状况、化疗耐受性及免疫功能。结果两组患者和辅助化疗前年龄、性别、临床分期、营养指标无显著性差异。试验组患者术后6个月PG-SGA评分为(2.12±0.69),显著低于对照组(4.37±0.75)(P<0.01);试验组营养不良比例显著低于对照组(P<0.05)。试验组化疗不良反应粒细胞减少症及血清转氨酸升高的发生率为14.3%(5/35),显著低于对照组51.4%(18/35)。试验组术后3个月及6个月复查CD4+T细胞、CD8+T细胞、NK细胞百分比以及Ig M、Ig G均较对照组显著升高(P<0.05)。结论全胃切除术后6个月辅助化疗期间,患者予添加谷氨酰胺的整蛋白型肠内营养粉(安素)营养支持,可改善患者营养状况和免疫功能,有助于患者顺利完成辅助化疗及提高生活质量。Objective To evaluate the effect of glutamine-enhanced enteral nutritional support on patients ' nutritional status and immunity during postoperative chemotherapy after radical total gastrectomy.Methods From October 2011 to March 2013,Seventy advanced gastric cancer patients undergoing radical total gastrectomy in our hospital were randomly divided into 2 groups, and received additional glutamineenhanced enteral nutritional(treatment group) and normal diet nutrition(control group) respectively during postoperative adjuvant chemotherapy. The nutritional status, patients' tolerance to chemotherapy and immunity were compared between the two groups. Results The PG-SGA score was(2.12±0.69) in the treatment group 6months after operation,significantly lower than(4.37±0.75) in the control group(P<0.01). The proportion of malnutrition in the treatment group was significantly lower than that in the control group(P <0.05). The incidence of chemotherapy adverse events including granulocytopenia and elevation of transaminase in the treatment group was 14.3%(5 / 35), significantly lower than 51.4%(18 / 35) in the control group(P<0.01). The proportions of CD4 + T and NK cells, and Ig M and Ig G levels in the treatment group were significantly higher than those in the control group 3 and 6 months after operation. Conclusions Glutamineenhanced nutritional support during postoperative adjuvant chemotherapy can improve the nutritional status and immunity for the patients with radical total gastrectomy. It can also contribute to completion of the whole chemotherapy course and improvement of the quality of life.

关 键 词：全胃切除 辅助化疗 肠内营养 营养状况 免疫功能 

分 类 号：R735[医药卫生—肿瘤]