围手术期肠内免疫营养对胃癌病人术后免疫功能和预后的影响  

The effects of perioperative enteral immunonutrition in patients with gastric cancer

作　　者：尹勇[1] 许军[1] 卢麒丞[1] 王勍[1] 李忠[1] 王海涛[1] 王荣朝[1] 

机构地区：[1]常州市第一人民医院胃肠外科,江苏常州213003

出　　处：《肠外与肠内营养》2008年第4期221-224,共4页Parenteral & Enteral Nutrition

基　　金：常州市科技局市指导性计划项目资助(CS2005901)

摘　　要：目的：观察围手术期肠内免疫营养（EIN）对胃癌病人术后免疫功能和预后的影响。方法：将46例胃癌病人随机分为围手术期EIN组（研究组，n=23）和术后EIN组（对照组，n=23）。研究组于术前7天和术后第2～8天接受EIN支持，对照组仅于术后第2～8天接受相同的EIN支持。于术前1天、术后第1天和第9天分别检测外周血淋巴细胞计数、免疫球蛋白（IgG、IgM、IgA）、T淋巴细胞亚群（CD4、CD8、CD4／CD8）和人类白细胞抗原·DR（HLA-DR）水平，观察两组病人术后感染性并发症和住院时间的差异。结果：研究组术后第9天淋巴细胞计数、IgG、CD4、CD4／CD8和HLA-DR的表达与对照组比显著升高（P〈0．05）。术后感染性并发症的发生率低于对照组（4．3％ vs 17．4％）。研究组术后平均住院时间比对照组缩短（10．8±1．0）d vs 5（11．8±1．2）d，P〈0．05。结论：围手术期应用EIN，更有利于病人术后免疫功能的恢复和预后改善。Objective：To evaluate the effects of perioperative enteral immunonutrition on immune function and clinical outcome in patients with gastric cancer. Methods： Forty-six patients were randomly allocated into two groups. The first group （n=23） received an enteral immune-enhancing diet 7 d before and 7 d after surgery and the second group （n=23） received the same diet but only 7 d after surgery. The total lymphocyte count （TLC）, immunoglobin （IgG, IgM, IgA）, T lymphocyte subsets and human leukocyte antigen-DR were determined as host immunity 1 d preoperatively, and 1, 9 d postoperatively. The differences between these two groups in postoperative infectious complications and postoperative hospital stay were observed. Results ： TLC, IgG, CD4, CD4/CD8 ratio and HLA-DR expression on postoperative day 9 were significantly higher in the perioperative group （P〈0.05 versus the postoperative group）. The rate of postoperative infectious complications in the perioperative group was lower than in the postoperative group （4.3 % vs 17.4% ）, but there was no significant difference （P〉 0.05）. Perioperative group also showed shorter average length of stay after surgery than postoperative group [（10.8±1.0）d versus （11.8±1.2）d, P〈0.05]. Conclusion ： Compared with the postoperative group, the perioperative administration of enteral immunonutrition can ameliorate the host immune function and improve clinical outcome in gastric cancer patients.

关 键 词：胃癌 肠内免疫营养 围手术期营养 

分 类 号：R735.2[医药卫生—肿瘤]