脂肪乳剂对胃肠肿瘤术后早期恢复阶段营养状况的影响
|
摘要
目的脂肪乳剂对胃肠肿瘤患者术后早期恢复阶段营养状况及炎症指标的影响。方法选择2015年1月-2017年12月本科室收治的胃肠肿瘤患者300例为研究对象,按照随机数字表法随机分为对照组和研究组。两组患者均给予全营养的肠外营养支持。研究组营养液在对照组基础上添加了新型鱼油脂肪乳剂(Lipoplus)。比较两组患者营养指标血清白蛋白、总蛋白、前白蛋白;炎症指标中性粒细胞计数、血清C-反应蛋白(CRP),细胞因子白介素10(IL-10)、白介素6(IL-6)、肿瘤坏死因子(TNF-α)的水平变化,观察患者全身炎性反应综合征(systemic inflammatoryresponse syndrome,SIRS)和医院感染的发生情况。结果两组患者白蛋白术后第3天与第6天水平差异比较无统计学意义,前白蛋白水平在术后第3天均下降,第6天均升高,两组比较差异有统计学意义(P<0.05);术后中性粒细胞计数均下降,且研究组术后第6天低于对照组(P<0.05)。血清C-反应蛋白水平术后第3天升高,随后开始降低,两组比较差异有统计学意义(P<0.05);两组患者术后细胞因子IL-10、IL-6、TNF-α比较差异均有统计学意义(P<0.05);术后两组患者SIRS发生率、感染率比较差异有统计学意义(χ~2=23.68,7.66;均P<0.05)。结论进行胃肠肿瘤手术后在恢复患者的营养安排中可添加鱼油,其能够恢复和改善胃肠肿瘤患者的营养及其免疫状况。
OBJECTIVE To explore the effect of fat emulsion on nutrition status and inflammatory factors of the gastrointestinal cancer patients during postoperative early recovery stage.METHODS A total of 300 patients with gastrointestinal cancer who were treated in surgery department from Jan 2015 to Dec 2017 were recruited as the study objects and randomly divided into the control group and the study group.Both groups were given parenteral nutrition support,while the study group was given additional novel fish oil fat emulsion(Lipoplus)on the basis of the treatment of the control group.The levels of nutrition indexes such as serum albumin,total protein and prealbumin were compared between the two groups of patients,the changes of levels of inflammatory factors neutrophils counts,serum C-reactive protein(CRP),interleukin-10(IL-10),interleukin-6(IL-6)and tumor necrosis factor(TNF-α)were observed,and the incidence rates of systemic inflammatory response syndrome(SIRS)and nosocomial infection were analyzed.RESULTS There was no significant difference in the albumin level between the two groups of patients after the surgery for 3 and 6 days,the prealbumin level was declined after the surgery for 3 days and elevated after the surgery for 6 days,and there was significant difference between the two groups(P<0.05).The serum CRP level was elevated after the surgery for 3 days and then began to decline,and there was significant difference between the two groups(P<0.05).There were significant differences in the levels of postoperative cytokines IL-10,IL-6 and TNF-αbetween the two groups of patients(P<0.05).There were significant differences in the incidence rates of postoperative SIRS and infection between the two groups of patients(χ~2=23.68,7.66;all P<0.05).CONCLUSION The parenteral nutrition adding with fish oil fat emulsion may facilitate the recovery and improvement of nutrition status and immunity of the gastrointestinal cancer patients.
OBJECTIVE To explore the effect of fat emulsion on nutrition status and inflammatory factors of the gastrointestinal cancer patients during postoperative early recovery stage.METHODS A total of 300 patients with gastrointestinal cancer who were treated in surgery department from Jan 2015 to Dec 2017 were recruited as the study objects and randomly divided into the control group and the study group.Both groups were given parenteral nutrition support,while the study group was given additional novel fish oil fat emulsion(Lipoplus)on the basis of the treatment of the control group.The levels of nutrition indexes such as serum albumin,total protein and prealbumin were compared between the two groups of patients,the changes of levels of inflammatory factors neutrophils counts,serum C-reactive protein(CRP),interleukin-10(IL-10),interleukin-6(IL-6)and tumor necrosis factor(TNF-α)were observed,and the incidence rates of systemic inflammatory response syndrome(SIRS)and nosocomial infection were analyzed.RESULTS There was no significant difference in the albumin level between the two groups of patients after the surgery for 3 and 6 days,the prealbumin level was declined after the surgery for 3 days and elevated after the surgery for 6 days,and there was significant difference between the two groups(P<0.05).The serum CRP level was elevated after the surgery for 3 days and then began to decline,and there was significant difference between the two groups(P<0.05).There were significant differences in the levels of postoperative cytokines IL-10,IL-6 and TNF-αbetween the two groups of patients(P<0.05).There were significant differences in the incidence rates of postoperative SIRS and infection between the two groups of patients(χ~2=23.68,7.66;all P<0.05).CONCLUSION The parenteral nutrition adding with fish oil fat emulsion may facilitate the recovery and improvement of nutrition status and immunity of the gastrointestinal cancer patients.
引文
[1]李子禹,吴舟桥,季加孚.中国胃肠肿瘤外科术后并发症诊断登记规范专家共识(2018版)[J].中国实用外科杂志,2018,38(6):589-595.
[2]聂孟良.50例胃肠肿瘤患者外科手术治疗疗效评价[J].当代医学,2017,23(15):47-50.
[3]吕素燕.胃肠肿瘤外科手术切口感染的康复指导分析[J].世界最新医学信息文摘,2018,18(78):225.
[4]孙存新.胃肠肿瘤外科手术治疗的临床疗效观察[J].锦州医科大学学报,2017,38(5):48-50.
[5]丁燕,王蓓,李久凡,等.胃肠肿瘤患者围手术期快速康复外科模式对术后恢复的影响[J].肿瘤代谢与营养电子杂志,2017,4(3):312-316.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]赵欢.营养支持在胃肠肿瘤中的临床应用[J].中国医药指南,2017,15(2):132-133.
[8]Nandivada P,Baker MA,Mitchell PD,et al.Predictors of failure of fish-oil therapy for intestinal failure-associated liver disease in children[J].Am J Clin Nutr,2016,104(3):663-670.
[9]尚闯,高阳,罗淼.胃肠肿瘤手术切口感染的预防研究[J].现代诊断与治疗,2017,28(24):4627-4629.
[10]McIntyre I,Carolan A,O′Sullivan M,et al.Incorporation of bioactive dairy hydrolysate influences the stability and digestion behaviour of milk protein stabilised emulsions[J].Food funct,2018,9(11):5813-5823.
[11]Sun C,Liu R,Sheng H,et al.Effect of microparticulation and xanthan gum on the stability and lipid digestion of oilin-water emulsions stabilized by whey protein[J].Food funct,2018,9(9):4683-4694.
[12]刘彦合,李慧,叶晓谊,等.胃肠肿瘤患者术后切口感染影响因素分析及对策[J].中华医院感染学杂志,2019,29(2):249-253.
[13]王群,杨志刚,严俊,等.胃肠肿瘤化疗患者营养风险筛查和营养支持状况分析[J].临床和实验医学杂志,2014,13(16):1358-1361.
[14]Liang L,Zhang X,Wang X,et al.Influence of dairy emulsifier type and lipid droplet size on gastrointestinal fate of model emulsions:in vitro digestion study[J].J Agric Food Chem,2018,66(37):9761-9769.
[15]Zhou FZ,Zeng T,Yin SW,et al.Development of antioxidant gliadin particle stabilized Pickering high internal phase emulsions(HIPEs)as oral delivery systems and the in vitro digestion fate[J].Food funct,2018,9(2):959-970.
[16]张莉红.胃肠肿瘤患者营养风险和营养支持与并发症关系[J].检验医学与临床,2017,14(5):725-726.
[17]Lavallee CM,MacPherson JAR,Zhou M,et al.Lipid emulsion formulation of parenteral nutrition affects intestinal microbiota and host responses in neonatal piglets[J].J Parenter Enteral Nutr,2017,41(8):1301-1309.
[18]徐鑫星.静脉营养支持治疗胃肠肿瘤手术患者的临床效果研究[J].齐齐哈尔医学院学报,2017,38(16):1957-1958.
[19]Hurt RT,Mundi MS.Use of mixed-oil fat emulsion to improve intestinal failure-associated liver disease in long-term home parenteral nutrition:a case report[J].J Parenter Enteral Nutr,2017,41(1_suppl):17S-19S.
[20]丁亚,赵瑞,于航娜,等.胃肠肿瘤患者术后进食与早期肠梗阻的关系及护理[J].解放军护理杂志,2017,34(1):61-63.
[21]邱志远,陶曙,雷珍,等.肿瘤异常蛋白在胃肠肿瘤中的临床价值[J].癌症进展,2016,14(4):340-342.
[22]Qin D,Yang X,Gao S,et al.Influence of hydrocolloids(dietary fibers)on lipid digestion of protein-stabilized emulsions:comparison of neutral,anionic,and cationic polysaccharides[J].J Food Sci,2016,81(7):C1636-1645.
[23]Kassis T,Yarlagadda SC,Kohan AB,et al.Postprandial lymphatic pump function after a high-fat meal:a characterization of contractility,flow,and viscosity[J].Am J Physiol Gastrointest Liver Physiol,2016,310(10):G776-789.
[24]Liu D,Parker HL,Curcic J,et al.The visualisation and quantification of human gastrointestinal fat distribution with MRI:a randomised study in healthy subjects[J].Br J Nutr,2016,115(5):903-912.
[25]董丹,李佳佳,尚宜星,等.胃肠肿瘤术后切口感染病原菌监测与预防性抗菌药物的选择分析[J].中华医院感染学杂志,2017,27(14):3248-3251.
[26]顾红柳,沙琦,张敏,等.胃肠肿瘤化疗患者血清IL-6、TNFα水平与营养状况的关系[J].武警后勤学院学报(医学版),2017,26(8):686-688.
[27]Zhang LS,Sato H,Yang Q,et al.Apolipoprotein A-V is present in bile and its secretion increases with lipid absorption in Sprague-Dawley rats[J].Am J Physiol Gastrointest Liver Physiol,2015,309(11):G918-G925.
[28]Fotos JS,Tulchinsky M.Oral cholecystagogue cholescintigraphy:a systematic review of fatty meal options[J].Clin Nucl Med,2015,40(10):796-798.
[2]聂孟良.50例胃肠肿瘤患者外科手术治疗疗效评价[J].当代医学,2017,23(15):47-50.
[3]吕素燕.胃肠肿瘤外科手术切口感染的康复指导分析[J].世界最新医学信息文摘,2018,18(78):225.
[4]孙存新.胃肠肿瘤外科手术治疗的临床疗效观察[J].锦州医科大学学报,2017,38(5):48-50.
[5]丁燕,王蓓,李久凡,等.胃肠肿瘤患者围手术期快速康复外科模式对术后恢复的影响[J].肿瘤代谢与营养电子杂志,2017,4(3):312-316.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]赵欢.营养支持在胃肠肿瘤中的临床应用[J].中国医药指南,2017,15(2):132-133.
[8]Nandivada P,Baker MA,Mitchell PD,et al.Predictors of failure of fish-oil therapy for intestinal failure-associated liver disease in children[J].Am J Clin Nutr,2016,104(3):663-670.
[9]尚闯,高阳,罗淼.胃肠肿瘤手术切口感染的预防研究[J].现代诊断与治疗,2017,28(24):4627-4629.
[10]McIntyre I,Carolan A,O′Sullivan M,et al.Incorporation of bioactive dairy hydrolysate influences the stability and digestion behaviour of milk protein stabilised emulsions[J].Food funct,2018,9(11):5813-5823.
[11]Sun C,Liu R,Sheng H,et al.Effect of microparticulation and xanthan gum on the stability and lipid digestion of oilin-water emulsions stabilized by whey protein[J].Food funct,2018,9(9):4683-4694.
[12]刘彦合,李慧,叶晓谊,等.胃肠肿瘤患者术后切口感染影响因素分析及对策[J].中华医院感染学杂志,2019,29(2):249-253.
[13]王群,杨志刚,严俊,等.胃肠肿瘤化疗患者营养风险筛查和营养支持状况分析[J].临床和实验医学杂志,2014,13(16):1358-1361.
[14]Liang L,Zhang X,Wang X,et al.Influence of dairy emulsifier type and lipid droplet size on gastrointestinal fate of model emulsions:in vitro digestion study[J].J Agric Food Chem,2018,66(37):9761-9769.
[15]Zhou FZ,Zeng T,Yin SW,et al.Development of antioxidant gliadin particle stabilized Pickering high internal phase emulsions(HIPEs)as oral delivery systems and the in vitro digestion fate[J].Food funct,2018,9(2):959-970.
[16]张莉红.胃肠肿瘤患者营养风险和营养支持与并发症关系[J].检验医学与临床,2017,14(5):725-726.
[17]Lavallee CM,MacPherson JAR,Zhou M,et al.Lipid emulsion formulation of parenteral nutrition affects intestinal microbiota and host responses in neonatal piglets[J].J Parenter Enteral Nutr,2017,41(8):1301-1309.
[18]徐鑫星.静脉营养支持治疗胃肠肿瘤手术患者的临床效果研究[J].齐齐哈尔医学院学报,2017,38(16):1957-1958.
[19]Hurt RT,Mundi MS.Use of mixed-oil fat emulsion to improve intestinal failure-associated liver disease in long-term home parenteral nutrition:a case report[J].J Parenter Enteral Nutr,2017,41(1_suppl):17S-19S.
[20]丁亚,赵瑞,于航娜,等.胃肠肿瘤患者术后进食与早期肠梗阻的关系及护理[J].解放军护理杂志,2017,34(1):61-63.
[21]邱志远,陶曙,雷珍,等.肿瘤异常蛋白在胃肠肿瘤中的临床价值[J].癌症进展,2016,14(4):340-342.
[22]Qin D,Yang X,Gao S,et al.Influence of hydrocolloids(dietary fibers)on lipid digestion of protein-stabilized emulsions:comparison of neutral,anionic,and cationic polysaccharides[J].J Food Sci,2016,81(7):C1636-1645.
[23]Kassis T,Yarlagadda SC,Kohan AB,et al.Postprandial lymphatic pump function after a high-fat meal:a characterization of contractility,flow,and viscosity[J].Am J Physiol Gastrointest Liver Physiol,2016,310(10):G776-789.
[24]Liu D,Parker HL,Curcic J,et al.The visualisation and quantification of human gastrointestinal fat distribution with MRI:a randomised study in healthy subjects[J].Br J Nutr,2016,115(5):903-912.
[25]董丹,李佳佳,尚宜星,等.胃肠肿瘤术后切口感染病原菌监测与预防性抗菌药物的选择分析[J].中华医院感染学杂志,2017,27(14):3248-3251.
[26]顾红柳,沙琦,张敏,等.胃肠肿瘤化疗患者血清IL-6、TNFα水平与营养状况的关系[J].武警后勤学院学报(医学版),2017,26(8):686-688.
[27]Zhang LS,Sato H,Yang Q,et al.Apolipoprotein A-V is present in bile and its secretion increases with lipid absorption in Sprague-Dawley rats[J].Am J Physiol Gastrointest Liver Physiol,2015,309(11):G918-G925.
[28]Fotos JS,Tulchinsky M.Oral cholecystagogue cholescintigraphy:a systematic review of fatty meal options[J].Clin Nucl Med,2015,40(10):796-798.