早期肠内营养对胃肠道肿瘤患者术后营养状况、免疫功能的影响  

Effect of enteral nutrition on nutrition status,immune function and prognosis of patients after surgery for gastroenteric cancer

作　　者：付红兵[1] 朱振新[1] 许超[1] 蔡清萍[1] 

机构地区：[1]第二军医大学长征医院普外二科,上海200003

出　　处：《中华临床医师杂志（电子版）》2012年第17期5079-5082,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的比较胃肠道肿瘤患者术后早期肠内营养与肠外营养支持的临床效果,探讨早期肠内营养对胃肠道肿瘤患者术后的临床应用价值。方法选择胃肠道肿瘤手术后需行营养支持的患者70例,随机分为肠内营养组(观察组,n=36)及肠外营养组(对照组,n=34)。对照组患者术后行静脉营养支持治疗,能量为25～35 kcal.kg-1.d-1。观察组术后给予早期肠内营养支持治疗。检测术前、术后营养状况指标及患者预后情况。结果 (1)两组患者体重在术前差异不显著,术后观察组患者的体重、白蛋白和前白蛋白水平较对照组高[(57.6±11.37)kg vs.(54.7±8.64)kg,(36.7±10.58)g/L vs.(34.2±9.04)g/L,(26.01±7.13)g/L vs.(22.27±6.35)g/L,P均<0.05]。(2)与对照组相比,观察组肠蠕动恢复时间提前,首次肛门排气时间和住院时间明显提前[(3.7±1.8)d vs.(4.6±1.2)d,(4.2±1.5)d vs.(5.9±2.1)d,(10.3±2.8)d vs.(14.1±4.7)d,P<0.05]。观察组出现腹部不适的人数较对照组多。(3)两组患者术后的淋巴细胞总数、CD3+、CD4+、CD8+细胞、CD4+/CD8+比值进一步降低,经营养支持后又不同程度的回升,以观察组的回升更明显[(1.28±0.54)×109/L vs.(1.17±0.41)×109/L,(59.61±9.67)%vs.(57.23±10.59)%,(33.16±8.32)%vs.(2.21±9.39)%,(26.10±4.93)%vs.(23.12±4.75)%,1.46±0.74 vs.1.42±0.54,P<0.05]。(4)两组患者术后并发症的发生率无显著性差异(P>0.05)。结论胃肠道肿瘤患者术后早期给予肠内营养支持可改善术后患者的营养状态,增强机体的免疫力,促进肠功能的早期恢复并缩短患者住院时间。Objective To compare the clinical effects of early enteral and parenteral nutrition,and to study their effects on nutritional status,immune function and prognosis in early postoperative patients with gastrointestinal cancer.Methods 70 patients with gastrointestinal cancer were randomly divided into early postoperative enteral nutrition group 19 cases(the experimental group)and parenteral nutrition group 17 cases(the control group).The control group was treated with parenteral nutrition support,and observation group was treated with early enteral nutrition therapy.The nutrition status of the patients was detected before and after operation.Results(1)The weight of patients had not significant difference before the surgery.After operation,the levels of the body weight,serum albumin and prealbumin in patients were higher than those in the control group[(57.6±11.37)kg vs.(54.7±8.64)kg,(36.7±10.58)g/L vs.(34.2±9.04)g/L,(26.01±7.13)g/L vs.(22.27±6.35)g/L,P<0.05].(2)Compare to the control group,intestinal peristalsis recovery time,the first time anal exsufflation time and hospital stay were short in the experimental group[(3.7±1.8)d vs.(4.6±1.2)d,(4.2±1.5)d vs.(5.9±2.1)d,(10.3±2.8)d vs.(14.1±4.7)d,P<0.05].There are significant differences(P<0.05).(3)After operation,total number of lymphocytes,CD3+,CD4+,CD8+ cell and CD4+/CD8+ ratio in patients reduced.There was vary degrees by nutritional support and recovery,the experimental group more visible[(1.28±0.54)×109/L vs.(1.17±0.41)×109/L,(59.61±9.67)% vs.(57.23±10.59)%,(33.16±8.32)% vs.(2.21±9.39)%,(26.10±4.93)% vs.(23.12±4.75)%,1.46±0.74 vs.1.42±0.54,P<0.05].There were significant differences(P<0.05).(4)The incidence of complications had no significant differences in two groups(P>0.05).Conclusions Compared with parenteral nutrition support,enteral nutrition support can efficiently ameliorate the nutrition state of the post-operative patients,and improve the gut barrier function and increase immunity of the post-operative patients.

关 键 词：肠道营养 营养状况 免疫 胃肠肿瘤 

分 类 号：R735[医药卫生—肿瘤]