免疫肠内营养对全胃切除老年患者营养及免疫调节作用  

Enteral immunonutrition in elderly patients with total gastrectomy improves nutritional status and immunoloregulation

作　　者：魏尉[1] 文旭[1] 李刚[1] 顾荣民[1] 明学志[1] 陈环球[1] 周斌[1] WEI Wei WEN Xu LI Gang GU Rong-min MING Xue-zhi CHEN Huan-qiu ZHOU Bin(Department of General Surgery, The Affliated Cancer Hospital of Nanjing Medical University/Jiangsu Cancer Hospital, Nanjing 210009, China)

机构地区：[1]江苏省肿瘤医院/南京医科大学附属肿瘤医院普通外科,南京210009

出　　处：《肿瘤代谢与营养电子杂志》2017年第2期204-207,共4页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：江苏省卫计委保健科研项目(BJ2014020)

摘　　要：目的探讨术后早期免疫增强型肠内营养治疗对全胃切除老年患者术后营养及免疫功能的影响。方法选择我院普外科2015年1月至2016年6月期间接受全胃切除术的68例进展期老年胃癌患者(>70岁)作为研究对象,手术后随机分为EN+PN和PN组。PN组患者在半流饮食后停用PN液。EN+PN组患者在手术后第1天经鼻饲管行生理盐水250ml,第2天经鼻肠管行肠内免疫营养制剂400ml(瑞能,华瑞制药有限公司,200ml/瓶),术后第4天增加至800~1200ml/d,并停用PN液。观察术后肛门排气恢复时间、术后并发症发生率、住院时间等,术前1天、术后第1天和第7天检测相关的营养和免疫血清指标,观察术后恢复情况,并比较和分析。结果两组患者术后第1天TP、PA、ALB、IgG、IgM水平以及CD4^+、CD8^+、CD4^+/CD8^+较术前1天有显著下降(P<0.05)。术后第7天EN+PN组血清TP、ALB、PA、IgG、IgM以及CD4^+、CD8^+、CD4^+/CD8^+与PN组比有显著性差异(P<0.05)。术后EN+PN组和PN组术后并发症无显著性差异(P>0.05)。结论老年胃癌患者行全胃切除术后早期应用免疫增强型肠内营养,可改善营养及免疫功能,是高龄患者术后营养治疗的选择之一。Objective To investigate the effects of enteral immunonutrition on recovery, nutritional status, immune function in elderly gastric cancer patients after total gastrectomy. Methods 68 cases of elderly gastric cancer patients postgastrectomy were randomly divided into total PN group, EN＋PN group. PN group stopped PN after taking semifuid diet. EN＋PN group were tube feeding 250ml saline at the frst day, 400ml PN at the second day and stopped PN after increasing to 800~1200ml at the 4th day. The recovery, serum marker on nutritional status and immune function were evaluated and compared before operation and on the 1st, 7th day after operation. Results The levels of serum total protein, albumin, prealbumin were signifcantly decreased in 2 groups on the 1st day after operation （P〈0.05）, and they were signifcantly increasedin EN＋PN group on the 7th days after operation （P〈0.05）. The levels of serum IgG, IgM, the helper cells （CD8^＋, CD4^＋） and ratio of CD4^＋, CD8^＋, （CD4^＋/CD8^＋） were signifcantly decreased in 2 groups on the 1st day （P〈0.05） after operation, and IgG, IgM, CD8^＋, CD4^＋and CD4^＋/CD8^＋ were significantly increased in EN＋PN group （P〈0.05） on the 7th day after operation. There were no signifcant difference in postoperative complication between 2 groups （P〉0.05）. Conclusions Postoperative early usage of enteral immunonutrition can improve the nutritional status and enhance immunity in elderly gastric cancer patients.

关 键 词：免疫增强型肠内营养 肠外营养 老年胃癌 围手术期 

分 类 号：R459.3[医药卫生—治疗学]