低氮低热量肠外营养联合肠内营养支持对胃癌患者炎性因子及免疫功能的影响  

Effects of low nitrogen and low calorie parenteral nutrition combined with enteral nutrition on inflammatory factors and immune function in patients with gastric cancer

作　　者：孙玉成[1] 金恩鸿[1] Sun Yucheng;Jin Enhong(Department of the First General Surgery,the Affiliated Hospital of Yanbian University,Yanji,Jilin 133000,China)

机构地区：[1]延边大学附属医院普外一科,吉林省延吉133000

出　　处：《中国基层医药》2018年第15期1925-1929,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨低氮低热量肠外营养联合肠内营养支持对胃癌患者炎性因子及免疫功能的影响.方法 选取延边大学附属医院2013年5月至2015年5月行手术治疗的胃癌患者90例为研究对象,根据营养支持方式不同分为对照组和观察组各45例.对照组采用全胃肠外营养支持;观察组采用低氮低热量肠外营养与肠内营养支持,并辅以针对性的护理措施.对比两组患者术前、术后7 d炎性因子及免疫蛋白水平变化情况.所有患者术后随访6个月,对比两组患者生存质量情况和护理满意率.结果 术后7 d,观察组免疫球蛋白IgA、IgM、IgG水平分别为（2.62 ±0.43）g/L、（1.93 ±0.52）g/L、（14.58 ±3.32）g/L,均显著高于术前的（2.01 ±0.30）g/L、（1.22 ±0.40）g/L、（12.42 ±5.64）g/L（t＝7.805、7.260、2.214,均P＜0.05）,且均高于对照组的（2.12 ±0.52）g/L、（1.53 ±0.41）g/L、（12.86 ±4.34）g/L（t＝4.971、4.052、2.112,均P＜0.05）;术后7 d,观察组C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）水平分别为（108.52 ±17.53）mg/L、（135.63 ± 28.51）ng/L,均低于术前的（142.35 ±15.82）mg/L、（156.65 ±25.54）ng/L（t＝9.611、3.684,均P＜0.05）,且均低于对照组的（135.68 ±14.54）mg/L、（145.52 ±27.53）ng/L（t＝8.000、3.824,均P＜0.05）,而白细胞介素2（IL-2）水平高于术前[（65.71 ±10.23） ng/L比（54.32 ±7.83） ng/L,t＝5.931,P＜0.05],且高于对照组的（57.62 ±5.86）ng/L（t＝4.603,P＜0.05）.术后6个月,观察组各项生存质量指标分值均较对照组高（t＝7.444、6.892、4.884、5.957、7.784、12.992、3.851、6.706,均P＜0.05）.观察组护理满意率为97.78%,高于对照组的82.22%（χ2＝6.049,P＜0.05）.结论 低氮低热量肠外营养联合肠内营养支持可以有效提高胃癌患者免疫功能,降低炎性反应,保障术后的生存质量,值得临床应用.Objective To investigate the effect of low nitrogen and low calorie parenteral nutrition combined with enteral nutrition support on inflammatory factors and immune function in patients with gastric cancer .Methods From May 2013 to May 2015,ninety patients with gastric cancer underwent surgical treatment in the Affiliated Hospital of Yanbian University were selected in the research ,and they were divided into control group and observation group according to different methods of nutritional support ,with 45 cases in each group.The control group received total parenteral nutrition support,the observation group was given low nitrogen and low calorie parenteral nutrition and enteral nutrition support, and supplemented by targeted nursing measures.The changes of levels of inflammatory factors and immune proteins in the two groups before operation and 7d after operation were compared.All patients were followed up for 6 months,and the quality of life and nursing satisfaction rate were compared between the two groups.Results At 7d after operation,the levels of immunoglobulin IgA ,IgM and IgG in the observation group were （2.62 ±0.43）g/L,（1.93 ±0.52）g/L,（14.58 ±3.32）g/L,respectively,which were significantly higher than those before operation [（2.01 ±0.30）g/L,（1.22 ±0.40） g/L,（12.42 ±5.64） g/L,t＝7.805,7.260,2.214,all P＜0.05] and those of the control group [（2.12 ±0.52） g/L,（1.53 ±0.41） g/L,（12.86 ±4.34） g/L,t＝4.971, 4.052,2.112,all P＜0.05].At 7d after operation,the levels of C reactive protein（CRP）,tumor necrosis factor -α （TNF-α） in the observation group were （108.52 ±17.53）mg/L,（135.63 ±28.51）ng/L,respectively,which were lower than those before operation [（142.35 ±15.82） mg/L,（156.65 ±25.54） ng/L,t ＝9.611,3.684,all P＜ 0.05] and those of the control group[（135.68 ±14.54）mg/L,（145.52 ±27.53）ng/L,t＝8.000,3.824,all P＜0.05],the level of interleukin-2（IL-2） was higher than those before operation [（65.71 ±10.23）ng/L vs.�

关 键 词：胃肠外营养 肠道营养 胃肿瘤 炎性介导素类 免疫 

分 类 号：R473.73[医药卫生—护理学]