老年胃癌患者术后低氮低热量肠外营养联合肠内营养的应用研究  

Application of Hyponitrogenic and Hypocaloric Parenteral Nutrition Combined with Enteral Nutrition Support to Old Patients with Gastric Cancer after Operation

作　　者：刘维群[1] 韩晓红[1] 何泽生[2] 文鸣[2] 

机构地区：[1]杭州师范大学附属医院营养科,杭州310015 [2]广西中医药大学附属瑞康医院

出　　处：《浙江中西医结合杂志》2013年第6期436-439,共4页Zhejiang Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的:探讨老年胃癌患者术后低氮低热量肠外营养联合肠内营养支持的临床应用价值。方法:采取随机对照试验方法,将87例老年胃癌患者随机分为低氮低热量肠外营养联合肠内营养治疗组(HHPN+EN)43例和全胃肠外营养组(TPN)44例。比较两组患者手术前后血清C反应蛋白(CRP)、白蛋白(ALB)、前白蛋白(PA)、免疫球蛋白、T细胞亚群,以及术后疲劳等指标的变化。结果:术后第7天,TPN组CRP显著高于HHPN+EN组(P<0.05)。两组血清PA水平均较术前显著升高(P<0.01),但HHPN+EN组升高更为明显(P<0.01)。术后HHPN+EN组血清IgA、IgM显著高于TPN组(P<0.01);CD3+、CD4+/CD8+亦高于TPN组(P<0.05,P<0.01),CD8+则低于TPN组(P<0.05)。与TPN组比较,HHPN+EN组术后第7天疲劳评分降低更为明显(P<0.05)。结论:老年胃癌患者术后低氮低热量肠外营养联合肠内营养支持可降低患者的应激反应,改善营养状况及免疫功能,减轻术后疲劳,营养支持效果优于传统的静脉营养。低氮低热量肠外营养联合肠内营养可能是老年胃癌患者术后一种较为理想的营养支持模式。Objective： To study the effect of hyponitrogenic and hypocaloric parenteral nutrition combined with en- teral nutrition support on old patients with gastric cancer after operation. Methods： Eighty-seven old patients with gastric cancer were randomly divided into 2 groups： hyponitrogenic and hypocaloric parenteral nutrition com- bined with enteral nutrition （HHPN ＋EN） group （n=43） and total parenteral nutrition （TPN） group （n=44）. Serum levels of C-reactive protein（CRP） , albumin（ALB） , prealbumin（PA） , immunoglobulins（IgA, IgG, and IgM） , and T-cell subpopulations were detected and compared before and after operation in both groups. Postoperative fatigue index were compared. Results： i. On day 7 offer operation, serum CRP of the TPN group was significant- ly higher than that of the HHPN＋EN group（P〈0.05）, ii. Serum levels of PA were both increased in the 2 groups after operation（both P〈0.01）, and the increase was more obvious in the HHPN＋EN group, iii. On day 7 offer operation, serum levels of IgA and IgG, percentage of CD3＋, and the ratio of CD4＋/CD8＋ were significant- ly higher in the HHPN＋EN group than those in the TPN group（P〈0.05,P〈0.01）. The percentage of CD8＋ was lower in the HHPN＋EN group（P〈0.05）, iv. Postoperative fatigue index was significantly, lower in the HHPN＋EN group than that in the TPN group in 7 days after operation（P〈0.05）. Conclusion： For old patients with gastric cancer after operation, HHPN＋EN support can reduce stress, improve nutritional status and immune function, and attenuate postoperative fatigue. The effect of HHPN＋EN support is better than traditional TPN. HHPN＋EN, therefore, may be an ideal nutrition support mode for old patients with gastric cancer after operation.

关 键 词：老年人 胃癌 手术 肠外营养 肠内营养 

分 类 号：R735.2[医药卫生—肿瘤]