谷氨酰胺强化肠内营养支持对全胃切除术后营养及免疫功能影响的研究  

Evaluation of glutamine-enhanced enteral nutritional support by gastro-duodenal route in the patients after total gastrectomy

作　　者：刘骅[1] 凌伟[1] 沈志勇[1] 金鑫[1] 曹晖[1] 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,上海200127

出　　处：《中国实用外科杂志》2010年第11期938-941,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨经胃十二指肠管谷氨酰胺强化肠内营养支持对全胃切除术后营养及免疫功能的影响。方法收集2006年10月至2009年2月上海交通大学医学院附属仁济医院普外科接受全胃切除术的72例进展期胃癌病人,随机分为谷氨酰胺强化肠内营养(EN+Gln)组、肠内营养(EN)组和对照组。在术后48h内待一般情况稳定后即开始给予肠内营养。观察肛门排气恢复时间、术后并发症发生率及住院时间,分别于术前1d、术后3d和12d检测总蛋白、白蛋白、前白蛋白、转铁蛋白,术后7d检测外周血NK细胞、CD4+T细胞、CD8+T细胞和免疫球蛋白IgM、IgG。结果 EN+Gln组与EN组术后并发症发生率及住院时间均低于对照组。术后第3天3组病人总蛋白、白蛋白、前白蛋白及转铁蛋白均较术前明显下降,且对照组总蛋白、白蛋白及转铁蛋白下降幅度更大(P<0.05),术后第14天时EN+Gln组与EN组的总蛋白、白蛋白、前白蛋白及转铁蛋白水平明显高于对照组(P<0.05)。术后第7天EN+Gln组CD4+T细胞、NK细胞百分比和IgM、IgG较术前明显升高,且较EN组和对照组同期显著升高(P<0.05)。结论全胃切除术病人围手术期谷氨酰胺强化肠内营养支持有助于改善营养和免疫状态、促进术后恢复,减少并发症发生率和缩短住院时间。Objective To evaluate glutamine-enhanced enteral nutritional support by gastro-duodenal route in the patients after total gastrectomy. Methods From October 2006 to February 2009, 72 patients receiving total gastrectomy at Department of General Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected. They were randomly divided into 3 groups： glutamine-enhanced enteral nutrition （EN ＋ Gin） group, enteral nutrition （EN） group and the control group. The patients received nutrition support within 48 h after operation for 7 days. The occurance of postoperative complication and hospitalization duration were compared. Besides serum total protein, albumin, proalbumin and transferrin were measured 1 day before operation, the 3rd day and the 12th day after operation. And on the 7th day ＇after operation, NK ceils, CD4＋T and CD8＋T cells, IgM and IgG levels in peripheral blood were measured. Results The occurrence of postoperative complication and hospitalization duration in the EN ＋Gln and EN group were fewer than those in the control group. The postoperative serum level of total protein, albumin, proalbumin and transferrin on the 3rd day after operation of all groups decreased significantly（P〈0.05） while those data of EN＋Gln and EN group on the 14th day after operation were significantly higher than those of the control group. On the,Tth day after operation NK cells, CD4 ＋ T cells, IgM and IgG levels of the EN ＋ Gin group increased prominently and significantly higher than those of EN and the control group. Conclusion For the patients receiving total gastrectomy, perioperative glutamine-enhanced nutritional support can improve nutrition and immune status and reduce the incidence of postoperative complication and hospital stay.

关 键 词：谷氨酰胺 肠内营养 全胃切除 营养状况 免疫功能 

分 类 号：R6[医药卫生—外科学]