早期肠内免疫微生态营养在胃癌术后患者中的应用价值  

Value of early enteral immune microecological nutrition in patients after surgery for gastric cancer

作　　者：范勇[1] 石磊[2] 晏殊[3] 雍伟[3] 

机构地区：[1]新昌县人民医院消化内科,浙江省绍兴市312500 [2]成都市第七人民医院医教部,四川省成都市610000 [3]成都市第七人民医院普外科,四川省成都市610000

出　　处：《世界华人消化杂志》2018年第3期159-164,共6页World Chinese Journal of Digestology

摘　　要：目的探讨在胃癌术后患者中早期应用免疫微生态肠内营养,对其营养状态、免疫功能和术后并发症的影响.方法选取2012-05/2017-05成都市第七人民医院收治的行胃癌根治术的150例患者,根据手术后营养支持方案的不同分为给予免疫微生态肠内营养支持的观察组(65例),和给予普通肠内营养支持的对照组(85例).然后将两组患者的免疫球蛋白、淋巴细胞数目、细胞因子CD4+、细胞因子CD8+、CD4+/C D8+比值等免疫指标、术后感染发生率等进行比较.结果在术后第1天,两组患者在免疫球蛋白G(immunoglobulin G,Ig G)、Ig M、CD4+、CD8+、CD4+/CD8+比值等免疫指标上无明显差异,不具有统计学意义(P>0.05);在手术后1 wk,观察组患者的Ig G、Ig M、免疫细胞数目、CD4、CD4+/CD8+比值明显高于对照组(7.82±1.91 vs 13.19±3.31、1.22±0.58 vs 2.68±0.56、36.09±8.21 vs 43.56±10.36、1.09±0.06vs 1.85±0.41),观察组患者的CD8+明显低于对照组(30.31±5.21 vs 21.85±6.08),差异均具有统计学意义(P<0.05);对照组患者住院期间的术后感染并发症发生率显著高于观察组(30.59%vs 12.31%),差异具有统计学意义(P<0.05).结论在胃癌术后患者中早期应用免疫微生态肠内营养的营养支持方案,能够显著改善患者的免疫状态,减少术后感染发生率,改善患者预后.AIM To investigate the effects of early enteral immune microecological nutrition on the nutritional status, immune function, and postoperative complications in patients after surgery for gastric cancer. METHODS One hundred and fifty patients who underwent radical gastrectomy at the Chengdu Seventh People＇s Hospital from May 2012 to May 201 were divided into two groups to receive either early enteral immune microecological nutrition support （observation group, n = 65） or conventional enteral nutrition support （control group, n = 85）. Immunoglobulins, the number of lymphocytes, immune indexes such as CD4＋T cells, CD8＋T cells, and CD4＋/ CD8＋ ratio, and the incidence of postoperative infection were compared between the two groups. RESULTS On the first postoperative day, there was no significant difference in IgG, IgM, CD4＋ T cells, CD8＋ T cells, or CD4＋/CD8＋ ratio between the two groups （P 〉 0.05）. One week after surgery, IgG, IgM, CD4＋ T cells, and CD4＋/CD8＋ ratio were significantly higher （13.19 ± 3.31 vs 7.82 ± 1.91, 2.68 ± 0.56 vs 1.22 ± 0.58, 43.56 ± 10.36 vs 36.09± 8.21, 1.85 ± 0.41 vs 1.09 ±0.06）, and CD8＋ T cells were significantly lower （21.85 ± 6.08 vs 30.31 ± 5.21） in the observation group than in the control group （P 〈 0.05）. The incidence of postoperative complications was significantly higher in the control group than in the observation group （30.59% vs 12.31%, P 〈 0.05）. CONCLUSION Early enteral immune microecological nutrition in patients after surgery for gastric cancer can significantly improve the immune status, reduce the incidence of postoperative infection, and improve the prognosis of patients.

关 键 词：胃癌 术后 肠内营养 微生态 免疫功能 

分 类 号：R735.2[医药卫生—肿瘤]