术前预康复对食管癌患者术后营养指标、人体体成分、血糖、炎症反应和免疫功能的影响  

Effect of Preoperative Prehabilitation on Nutritional Indicators, Body Composition, Blood Glucose, Inflammatory Response and Immune Function of Patients with Esophageal Cancer after Operation

作　　者：谢琪[1] 王强[3] 雷敏[4] 刘新波[2] 赵梦然 XIE Qi;WANG Qiang;LEI Min;LIU Xin-bo;ZHAO Meng-ran(Department of Nutrition,.the Fourth Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Thoracic Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China;.Department of Nutrition,the Third Hospital of Hebei Medical University,Shijiazhuang 050000,China;Nursing School of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第四医院营养科,石家庄050000 [2]河北医科大学第四医院胸外科,石家庄050000 [3]河北医科大学第一医院胸外科,石家庄050000 [4]河北医科大学第三医院营养科,石家庄050000 [5]河北医科大学护理学院,石家庄050000

出　　处：《临床误诊误治》2019年第12期87-93,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划(20170695)

摘　　要：目的探讨术前预康复对食管癌患者术后营养指标、人体体成分、血糖、炎症反应和免疫功能的影响。方法选取2017年1月—2018年12月我院收治的食管癌256例作为研究对象,根据治疗方法的不同分为观察组与对照组,每组各128例。两组均予术前及术后常规干预措施,在此基础上,观察组予术前预康复干预措施。观察两组术后营养相关指标(如白蛋白、前白蛋白、转铁蛋白、血红蛋白)、人体体成分(如体重、体质量指数、蛋白质、无机盐等)、免疫功能相关指标(如IgG、IgA、IgM、CD4等)、术后情况(如恶心、呕吐、腹泻等)、血糖波动值及炎症指标(白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α)的水平变化。结果与对照组比较,观察组术后3 d、术后7 d、术后15 d白蛋白、前白蛋白、转铁蛋白、血红蛋白水平升高及血糖波动值降低,术后3 d~术后7 d体质量指数、蛋白质、体水分、细胞内水分、身体细胞量变化值降低及骨矿物含量变化值升高,术后3 d、术后7 d的IgG、IgA、IgM、CD3、白细胞介素-6、C-反应蛋白、肿瘤坏死因子-α水平升高及CD8水平降低,差异有统计学意义(P<0.05)。两组术后恶心、肺炎、吻合口瘘、重症监护室住院时间、住院费用及术后首次排便时间比较差异具有统计学意义(P<0.05)。结论术前预康复干预可明显改善食管癌患者术后营养状况、免疫功能、人体体成分和炎症相关指标,减轻术后并发症的发生率,降低重症监护室住院时间、血糖波动值及住院费用,值得临床推广应用。Objective To study the effect of preoperative prehabilitation on nutritional indicators,body composition,blood glucose,inflammatory response and immune function of patients with esophageal cancer after operation.Methods A total of 256 cases with esophageal cancer admitted to our hospital from January 2017 to December 2018 were selected for the study.They were randomly divided into observation group and control group according to random number table method,with 128 cases in each group.Both groups were given conventional intervention before and after operation,and the observation group was supplemented with prehabilitation intervention before operation.The changes in nutrition related indexes(albumin,prealbumin,transferrin,and hemoglobin),body composition[body weight,body mass index(BMI),protein,and inorganic salt],immune function related indexes(IgG,IgA,IgM,and CD4),postoperative condition(nausea,vomiting,and diarrhea),blood glucose fluctuations and inflammatory markers[interleukin-6(IL-6),c-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]were observed.Results Compared with the control group,the levels of albumin,prealbumin,transferrin,and hemoglobin were increased and the fluctuations of blood glucose were decreased in the observation group at 3,7 and 15 days after operation.BMI,protein,body water,intracellular water,body cell volume were decreased and bone mineral content was increased at 3 and 7 days after operation.The IgG,IgA,IgM,CD3,IL-6,CRP and TNF-αin the observation group at 3 and 7 days after operation were significantly higher than those of normal controls.while the levels of CD8 was significantly reduced(P<0.05).There were significant differences between the two groups in postoperative nausea,pneumonia,anastomotic leakage,length of ICU stay,cost of hospitalization and time of first defecation(P<0.05).Conclusion Preoperative prehabilitation intervention can significantly improve postoperative nutritional status immune function,body composition,and inflammation-related indicators in patients with

关 键 词：食管癌 术前预康复 营养支持 身体成分 免疫功能 

分 类 号：R735.1[医药卫生—肿瘤]