早期肠内营养联合肠黏膜保护对胰腺癌根治术后患者营养不良、免疫功能和胃肠功能的影响  

Effects of early enteral nutrition combined with intestinal mucosal protection on malnutrition,immune function,and gastrointestinal function in patients after radical resection of pancreatic cancer

作　　者：高灵花 陈颖 沈金花 GAO Ling-hua;CHEN Ying;SHEN Jin-hua(Department of Pancreatic Surgery,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,CHINA;Critical Care Unit,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,CHINA)

机构地区：[1]复旦大学附属华山医院胰腺外科,上海200040 [2]复旦大学附属华山医院危重症室,上海200040

出　　处：《海南医学》2023年第18期2595-2598,共4页Hainan Medical Journal

基　　金：上海市静安区卫生科研课题(编号:2020MS07)。

摘　　要：目的探讨早期肠内营养联合肠黏膜保护对胰腺癌根治术后患者营养不良、免疫功能和胃肠功能的影响。方法选取2020年4月至2022年4月复旦大学附属华山医院收治的93例胰腺癌根治术后患者为研究对象,依照区组随机化分组法将其分为对照组46例和观察组47例。对照组患者实施常规治疗,观察组患者实施早期肠内营养联合肠黏膜保护治疗。比较两组患者术后恢复情况(肛门排气时间、排便时间、胃管留置时间),以及术前、术后2周的免疫功能[血清免疫球蛋白G(IgG)、血清免疫球蛋白A(IgA)、血清免疫球蛋白M(IgM)、CD4细胞/CD8细胞(CD4/CD8)]、胃肠功能[胃泌素(GAS)、胃动素(MTL)]和术后两周内的并发症发生情况。结果术后,观察组患者的肛门排气时间、排便时间、胃管留置时间分别为(2.27±0.46)d、(3.16±0.64)d、(5.22±1.63)d,明显优于对照组的(2.59±0.54)d、(3.57±0.75)d、(6.11±1.74)d,差异均有统计学意义(P<0.05);术后2周,两组IgG、IgA、IgM、CD4/CD8、GAS、MTL水平较术前均有升高(P<0.05),且观察组分别为(16.28±3.09)g/L、(3.16±0.67)g/L、(1.41±0.24)g/L、1.77±0.31、(84.65±9.16)μmol/L、(296.24±31.66)ng/L,明显高于同期对照组的(14.72±3.64)g/L、(2.82±0.59)g/L、(1.25±0.23)g/L、1.64±0.30、(79.20±8.79)μmol/L、(276.69±28.53)ng/L,差异均有统计学意义(P<0.05);术后2周内,观察组患者术后营养不良发生率、并发症总发生率分别为0、10.64%,明显低于对照组的15.21%、34.78%,差异均有统计学意义(P<0.05)。结论早期肠内营养联合肠黏膜保护能加快胰腺癌根治术后患者恢复,同时还能提高患者免疫功能和胃肠功能,减少术后营养不良和并发症的发生,具有较高临床应用价值。Objective To explore the effects of early enteral nutrition combined with intestinal mucosal protection on malnutrition,immune function,and gastrointestinal function in patients after radical resection of pancreatic cancer.Methods Ninety-three patients after radical resection of pancreatic cancer in Huashan Hospital Affiliated to Fudan University from April 2020 to April 2022 were selected as research subjects,and they were divided into a control group(46 cases)and an observation group(47 cases)according to block randomization method.The patients in a control group received conventional treatment,while those in observation group received early enteral nutrition combined with intestinal mucosal protection.Postoperative recovery situation(anal exhaust time,defecation time,gastric tube indwelling time),immune function[serum immunoglobulin G(IgG),serum immunoglobulin A(IgA),serum immunoglobulin M(IgM),CD4 cell/CD8 cell(CD4/CD8)]and gastrointestinal function[gastrin(GAS),motilin(MTL)]before surgery and at 2 weeks after surgery,and occurrence of complications within 2 weeks after surgery were compared between the two groups of patients.Results The anal exhaust time,defecation time,and gastric tube indwelling time were(2.27±0.46)d,(3.16±0.64)d,(5.22±1.63)d in the observation group after surgery,significantly better than(2.59±0.54)d,(3.57±0.75)d,(6.11±1.74)d in the control group(P<0.05).At 2 weeks after surgery,the levels of IgG,IgA,IgM,CD4/CD8,GAS,and MTL in both groups were increased compared with those before surgery(P<0.05),and the above levels in the observation group[(16.28±3.09)g/L,(3.16±0.67)g/L,(1.41±0.24)g/L,1.77±0.31,(84.65±9.16)μmol/L,(296.24±31.66)ng/L]were significantly higher than those in the control group[(14.72±3.64)g/L,(2.82±0.59)g/L,(1.25±0.23)g/L,1.64±0.30,(79.20±8.79)μmol/L,(276.69±28.53)ng/L],P<0.05.Within 2 weeks after surgery,the incidence rate of postoperative malnutrition and total incidence rate of complications were 0 and 10.64%in the observation group,which were significa

关 键 词：胰腺癌 胰腺癌根治术 早期肠内营养支持 肠黏膜保护 营养不良 免疫功能 胃肠功能 

分 类 号：R735.9[医药卫生—肿瘤]