进展期胃癌根治术后全胃肠外营养支持对患者免疫功能的影响  

Effects of postoperative TPN on immunocompetence inpatients with advanced gastric cancer

作　　者：陆巧[1] 王吉甫[2] 

机构地区：[1]惠州市中心人民医院外科,广东省惠州516001 [2]广州中山医科大学附属第一医院外科

出　　处：《中国基层医药》2007年第5期798-799,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨进展期胃癌施行根治性胃切除术（RG）后应用全胃肠外营养（TPN）支持对患者免疫功能的影响。方法 将45例胃癌患者随机分为两组：静脉营养组（TPN组，n=26）每日供能150～200KJ／kg，供氮0．2g／kg，其中30％～40％非蛋白热能由10％脂肪乳提供，60％～70％由葡萄糖提供；对照组（非TPN组，n=19）每日供能150～200KJ／kg，均由葡萄糖提供，每日供氮0．2g／kg。两组术后静脉营养期间均无进食。分别在术前和术后9d检测患者外周血NK细胞活性和T细胞亚群的变化。结果 RG术后无论是否给予TPN支持，均可见NK细胞活性、CD4^＋细胞和CD4^＋／CD8^＋细胞比值明显升高，而CD8^＋细胞明显下降。RG术后TPN组NK细胞活性、CD3^＋细胞、CD4^＋细胞、CD4^＋／CD8^＋细胞比值显著高于非TPN组（P〈0．01）。结论 除胃癌根治术能改善患者免疫状态外，术后营养支持包括应用脂肪乳剂能进一步改善患者免疫功能。Objective To explore effects of postoperative total parenteral nutriton（TPN） on immunocompetence in patients with advanced gastric cancer（AGC）. Methods 45 patients with AGC were randomly allocated into two groups. （ 1 ） In TPN group（ n = 26）, the patients were provided with 150 - 200KJ·kg^-1·d^-1 of energy and 0.2g·kg^-1·d^-1of nitrogen. 30 % - 40 % of non-protein energy was supplied with 10 % intrahpid, and 60 % - 70 % with glucose. TPN were used for 8- 10 days continuously after RG. （2）In non-TNP group, the patients were intra- venously provided with 150- 200KJ·kg^-1·d^-1 with glucose and 0.2g·kg^-1·d^-1 of nitrogen. 45 patients were respecdtively tested in their NK cell activity and T cell subsets preoperatively and on the 9th day postoperatively. Resuits The results showed the following：Whether receiving TPN after RG, the NK cell activity, CD4^＋ cell and CD4^＋ / CD8^＋ ratio were elevated significantly ,and CD8^＋ cell decreased（P 〈 0.05 ）;The NK cell activity CD3^＋ cell, CD4^＋ cell and CD4^＋/CD8^＋ ratio rose significantly in TPN group compared with non-TPN group after RG（ P 〈 0.01 ）. Conclusion Not only could RG improve the immunefunctionof AGC patients,but also the postoperative nutrition support including fat emulsion could futher improve immune status of the patients without any disadventageous effect.

关 键 词：胃肿瘤 胃肠外营养 免疫测定 根治术 

分 类 号：R735[医药卫生—肿瘤]