胃肠道肿瘤患者术后早期肠内营养与肠外营养支持的随机对照研究  

Early Postoperative Enteral Versus Parenteral Nutrition in Patients with Gastrointestinal Cancer:A Randomized Controlled Trial

作　　者：罗世成[1] 郭建辉[1] 朱军[1] 卓卫东[1] 张丽萍[2] 

机构地区：[1]云南省第一人民医院普外二科,昆明650032 [2]云南省第一人民医院基础研究室

出　　处：《中国普外基础与临床杂志》2007年第3期324-328,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较胃肠道肿瘤患者术后早期肠内营养(EN)与肠外营养(PN)支持的临床效果,探讨其对细胞因子、细胞免疫功能和蛋白质代谢变化的影响。方法36例胃肠道肿瘤根治术后患者,随机分为早期EN组19例,早期PN组17例,术后1d分别采取EN和PN支持。术前3d和术后1、3、5d检测患者血清TNF-α、IL-1β、IL-6和IL-10水平,淋巴细胞总数及其亚群CD3、CD4、CD8、CD4/CD8和NK细胞,24h尿素和尿肌酐排泄量。比较两组患者的临床恢复指标、并发症发生率等。结果两组术后血清IL-1β、IL-6、IL-10和24h尿素及肌酐排泄量多较术前有不同程度升高,血清TNF-α和淋巴细胞总数(除EN组术后3、5d)明显下降,淋巴细胞亚群分布比例无明显变化。两组间比较:IL-1β、IL-10及TNF-α变化差异无统计学意义,术后EN组IL-6(3、5d)、24h尿素排泄量(3、5d)和尿肌酐排泄量(3、5d)与PN组同期相比明显降低(P<0.05),淋巴细胞总数(3、5d)较PN组高(P<0.05)。EN组术后感染并发症发生率、发热时间、住院时间和医疗费用均较PN组低(P<0.05)。结论胃肠道肿瘤患者术后早期EN支持较PN支持更具优越性,可降低手术应激导致的细胞因子释放和蛋白质分解代谢反应程度,缩短炎症反应时间,降低患者术后感染并发症发生率,缩短住院时间,降低医疗费用。Objective To compare the clinical effects of early enteral and parenteral nutrition, and to study their effects on cytokine release, cellular immune function and protein metabolism in early postoperative patients with gastrointestinal cancer. Methods Thirty-six patients with gastrointestinal cancer were randomly divided into early postoperative enteral nutrition （EN） group （19 cases） and parenteral nutrition （PN） group （17 cases）, and they were supported with EN or PN during postoperative period of 1 - 7 days, respectively. The levels of serum tumor necrosis factor-α （TNF-α）, interleukin-1β （IL-1β）, interleukin-6 （IL-6）, and interleukin-10 （IL-10） were measured by ELISA. The total lymphocyte count （TLC） and subgroups of lymphocyte （CD3、CD4、CD8、CD4/CD8 and NK cell） were determined with flow cytometer. The urea and creatinine of the 24 h excretory urine were examined at four different phases： preoperative （pre）, 1st d, 3rd d and 5th d after operation （pod）. The clinical recovery indicators and the complication incidence were also observed. Results All the patients followed the project of nutri tional support and relevant examinations, and there was no severe complication and no patient died during the research. The IL-1β, IL-6 and IL-10, the 24 h urea and creatinine increased, while the serum TNF-α and TLC （except 3, 5 pod of EN group） decreased. There was no marked change of the proportion of lymphocyte subgroups after operation and there was no significant difference of the changes of IL-1β, IL-10 and TNF-α between the two groups as well. The levels of IL-6 （3, 5 pod）, the 24 h urea （3, 5 pod） and creatinine （3, 5 pod） were significantly lower in EN group than those in PN group （P〈0.05）, whereas TLC （3, 5 pod） were significantly higher than that in EN group （P〈0.05）. In addition, the postoperative infection incidence （10.5% vs 35.3% ）, fever duaration, rehabilitation time and medical cost were significantly lower i

关 键 词：胃肠道肿瘤 营养支持 围手术期 

分 类 号：R735[医药卫生—肿瘤]