围手术期口服肠内营养制剂对结直肠癌患者术后营养免疫状况及术后并发症的影响  

Effect of perioperative oral enteral nutrition on nutritional status, immune function and postoperative complication rate in patients with colorectal cancer

作　　者：沈海滨[1] 刘小金[1] 刘锐[1] 沈忠[2] SHEN Haibin;LIU Xiaojin;LIU Rui;et al(Department of Surgery, Hangzhou Third People＇s Hospital, Hangzhou 310009, China)

机构地区：[1]杭州市第三人民医院普外科,310009 [2]杭州市第三人民医院肛肠科,310009

出　　处：《浙江医学》2018年第8期843-847,共5页Zhejiang Medical Journal

基　　金：杭州市卫生计生科技计划项目(2015A17)

摘　　要：目的探讨围手术期口服肠内营养制剂对结直肠癌患者术后营养状况、免疫功能及术后并发症的影响。方法选取行根治性切除术的结直肠癌患者80例为研究对象,按随机数字表法分为观察组(术前3d及术后早期给予口服肠内营养制剂瑞能)和对照组(术前3d及术后早期给予传统饮食)各40例。观察并比较两组患者入院时肠道准备不良反应、术中肠道清洁度、术后肛门排气时间及并发症发生情况,监测并比较两组患者入院时、术后1d、术后7d的营养指标(体重、BMI、上臂中部肌肉周长、Hb、血清总蛋白、血清白蛋白、血清前白蛋白、血清转铁蛋白)和免疫功能指标(T淋巴细胞亚群、免疫球蛋白及补体)。结果观察组患者肠道准备不良反应低于对照组(P<0.05),而术中肠道清洁度两组比较差异无统计学意义(P>0.05)。观察组患者术后肛门排气时间早于对照组(P<0.05),术后感染性并发症发生率低于对照组(P<0.05),而非感染性并发症发生率两组比较差异无统计学意义(P>0.05)。入院时,两组患者营养指标、免疫功能指标比较,差异均无统计学意义(均P>0.05);术后1d,差异亦均无统计学意义(均P>0.05);术后7d,观察组营养指标、免疫功能指标均优于对照组(均P<0.05)。结论结直肠癌围手术期给予口服肠内营养制剂有助于肠道清洁,改善患者营养免疫状况,减少术后并发症的发生,是一种安全、简便的方法,可在临床推广应用。Objective To investigate the effect of perioperative oral enteral nutrition on nutritional status, immune function and postoperative complications rate in patients with colorectal cancer. Methods Eighty patients with colorectal cancer undergoing radical resection were randomly assigned in two groups with 40 cases in each. Patients in study group received enteral nutrition support 3 d before surgery and early period of postoperation, while patients in control group received conventional postoperative care protocol. The tolerance, intestinal cleanliness, time of first flatus/defecation and incidence of postoperative complications were compared between the two groups. Meanwhile, the nutritional status indicators including body weight, BMI,TSF, AMC, Hb, TP, ALB, PA, TRF, and immune function indicators including CD3＋, CD4＋, CD4＋/CD8＋, IgA, IgM, IgG, C3, C4 were measured and analyzed before and 1 d, 7 d after surgery. Results The patients＇ tolerance in study group was better than that in control group（P〈0.05）, but there was no significant difference in intestinal cleanliness between two groups（P〈0.05）. In the study group, the time of first flatus/defecation was significantly shorter（P〈0.05）. There were no significant differences in nutritional indicators and immune function indicators at the admission between two groups（all P〈0.05）. One day after the operation, there was no statistical significance（P〈0.05）, while the indicators of nutritional status and immune function in study group were better than those in control group 7 d after operation（all P〈0.05）. Conclusion In patients with colorectal cancer, perioperative oral enteral nutrition can improve intestinal cleanliness, accelerate the recovery of intestinal function, improve the nutritional status and immune function, and reduce the incidence of postoperative complications.

关 键 词：结直肠癌 肠内营养 免疫功能 围手术期 并发症 

分 类 号：R735.34[医药卫生—肿瘤]