早期肠内营养对食管癌术后全身炎性反应及细胞免疫功能的影响  

The effects of early enteral n utrition on the suppression of excessive systematic inflammatory responses and immunological competence in patients foll owing esophageal cancer surgery.

作　　者：谢天鹏[1] 赵雍凡[1] 刘华英[1] 付茂勇[1] 解晨昊[1] 冯伟华[1] 

机构地区：[1]四川大学华西医院

出　　处：《四川医学》2005年第1期18-20,共3页Sichuan Medical Journal

摘　　要：目的　观察食管癌术后早期肠内营养支持对术后营养状态、全身炎性反应、免疫功能的影响。方法　 60例食管癌根治术患者随机分为两组 ,肠内营养组 (enteralnutrition ,EN组 )与肠外营养组 (parenteralnutrition ,PN组 ) ,每组各 3 0例。EN组术后 2 4h以内管喂肠内营养液能全力 ,PN组给予等氮、等热卡的肠外营养 ,营养支持共 7d。观察两组病人术前后营养指标、炎性反应指标及细胞免疫指标的变化。结果　①两组病人术前、后白蛋白变化无统计学意义 (P >0 .0 5 ) ,EN组术后第 8d前白蛋白、转铁蛋白水平明显较PN组高 (P <0 .0 5 )。②术后两组病人CRP、IL 6、TNF α水平均明显升高 ,EN组CRP、IL 6、TNF α水平均较PN组低 (P <0 .0 5 )。③CD3 + 、CD4+ 、CD8+ 、CD4+ /CD8+ 、NK等细胞免疫指标两组病人术前后变化比较无统计学意义 (P >0 .0 5 )。结论　食管癌术后早期肠内营养有利于蛋白合成代谢 ,能减轻术后的全身炎性反应 ,是值得推广的营养支持方式。Objective To determine the effects of early enteral n utrition(EN)on nutritional status,the su ppression of excessive systematic inflam matory responses,and immunological compe tence in patients following esophageal c ancer surgery.Methods Sixty patients who u nderwent the same elective operation for thoracic esophageal carcinoma were pros pectively randomized into an early enter al nutrition(EN) group who received naso -duodenal infusion with nutrision from p o stoperative day(pod)1 and a parenteral n utrition(PN)group. The nutritional goal was 25～30 kcal/kg·day.Both groups receiv ed isocaloric and isonitrogenous nutriti onal formulas on the same postoperative day.Nutritional parameters,systematic in flammatory responses,and immune status i n the blood were measured preoperatively and on the 3rd,and 8th day postoperativ ely.Results There was no signifi cant difference in Alb between the two g roups(P>0.05).On the pod8,serum PAB an d TRF levels in the EN group were signif icant higher than in the PN group(P<0. 05).CRP,IL-6,and TNF-α in sera was signi ficantly higher after operation in both groups.In the EN group,however,significa ntly less CRP,IL-6,and TNF-α production was observed on the pod3 and pod8(P<0. 05).No significant changes of T lymphocy te subset parameters and NK lymphocyte w ere observed in both groups(P>0.05).Conclusion EN provides bette r resume of hepatic protein synthesis.Ea rly enteral nutrition may have beneficia l effects on the suppression of excessiv e inflammatory responses. Patients under g oing radical esophageal surgery might be nefit the most from early enteral nutrit ion.

关 键 词：肠内营养 肠外营养 食管癌 炎性反应 免疫功能 

分 类 号：R735.1[医药卫生—肿瘤]