大肠癌术后早期肠外营养支持的临床研究  

Clinical study of postoperative early use of parenteral nutrition in patients with large intestinal tumor

作　　者：王海鹏[1] 田小林[1] 戴凌[1] 莫一琨[1] 

机构地区：[1]桂林医学院附属医院普外科,广西桂林541001

出　　处：《华夏医学》2004年第3期315-317,共3页Acta Medicinae Sinica

摘　　要：目的 :研究大肠癌术后早期全肠外营养 (TPN)支持的临床效果。方法 :对 6 0例大肠癌患者根治术后 ,随机分为实验组 (TPN组 )和对照组 (非 TPN组 )。分别于手术前、手术后第 1天及第 7天检测 Ig G,Ig A,Ig M,C3,T细胞亚群 ;以及手术前后体重 ,血红蛋白 ,血清白蛋白 ,血清总蛋白 ,血糖的测定。结果 TPN组术后并发症发生率为 2 6 .7% (8/30 ) ,对照组为 2 3.3% (7/ 30 ,P>0 .0 5 ) ,病死率为 3.3% (1 / 30 )。 TPN组血清白蛋白、总蛋白及血糖水平较术前明显升高 (P<0 .0 5 ) ,体重丢失较对照组减少 (P<0 .0 5 )。大肠癌患者术前均有不同程度的免疫功能低下 ,手术后第 1天Ig G、lg A、Ig M、C3较术前明显下降 ,术后第 7天 TPN组恢复较快 ,除 Ig M外均达到或超过术前水平 ,与非 TPN组比较差异有显著意义 (P<0 .0 1 )。 CD+ 3、CD+ 4、CD+ 4/ CD+ 8比值术后第 1天下降明显 ,而 TPN组术后第 7天迅速恢复并超过术前水平 ,与非 TPN组比较差异有显著意义 (P<0 .0 1 )。结论 :大肠癌患者术后应用 TPN具有改善营养状态、增加手术耐受能力 ,同时可以有效地改善机体的免疫功能 。Objective: To study the effects of postoparetive early total parenteral nutrition (TPN) in the patients with large intestinal tumor. Methods: 60 patients with large intestinal cancer were grouped into two at random,one was TPN supplement group (namely,the experimental group), and the other is non TPN group(namely,the control group).The patients were tested for their IgA、 IgM、 lgG、 C 3 and T cell subgroup at the lst and 7th day before and after the operation respectively. Meanwhile, before and after the operation, the patients were also tested for their weight, haemoglobin(Hb), serum albumin, the total protein of the serum, and the blood glucose. Results: In the experimental group, the occurrence rate of the complication was 26.7%(8/30), higher than 23.3%(7/30)in the control group(P>0.05), and the death rate was 3.3%(1/30). The level of the Hb, the total protein of the serum and the blood glucose increased more obviously than those in the control group, but the weight reduced less than that in the control group (P<0.05).And the immunity level of the patients decresed a little bit to some degree befor the operation.The level of IgG,IgA, IgM and C 3 reduced more obviously in the lst day after the surgery, but they recovered more quickly than those in the control group,and even reached or surpassed the original level for the patients in the seventh day in the experimental group except for the IgM level. Compared with the control group, difference was significant (P<0 01).Besides,the specific value of CD + 3, CD + 4, CD + 4/CD + 8 droped obviously at the first day after the surgery;while the ratio in the exprimental group recoverd and even surpassed the original level.There was a big difference between the experimental group and the control one (P<0.01). Conclusion: TPN can improve the nutritional condition, increase the endurance against the operation, and improve the immunity of the patients, but it can't reduce the complication rate.

关 键 词：大肠肿瘤 胃肠外高营养 营养状况 免疫功能 

分 类 号：R735.34[医药卫生—肿瘤]