术后早期肠内和肠外营养联合支持治疗对胃癌根治术患者早期预后的影响
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摘要
目的探讨术后早期肠内和肠外营养联合支持治疗对胃癌根治术患者早期预后的影响。方法选取2016年3月—2017年9月收治的胃癌根治术患者80例,根据不同的营养治疗方式分为对照组和观察组,每组40例。对照组采取单纯肠外营养支持治疗,观察组采取肠内和肠外营养联合支持治疗。比较2组术后1 d和7 d的细胞免疫和体液免疫指标,并观察2组术后住院时间、肛管排气时间、并发症及病死率情况。结果术后7 d,2组CD3+和CD4+细胞比例、CD4+/CD8+比值以及IgA、IgG和IgM水平均较术后1 d有所升高,且观察组较对照组升高更明显(P<0.05)。术后7 d,2组CD8+细胞比例较术后1 d均有所下降,且观察组较对照组下降幅度更明显(P<0.05)。观察组术后住院时间、肛管排气时间、吻合口瘘、残胃无力和伤口感染发生率以及病死率均低于对照组(P<0.05)。结论术后早期进行肠内和肠外营养联合支持治疗,有利于改善胃癌根治术患者的免疫功能,减少住院时间,降低术后并发症发生率和病死率。
Objective To investigate effect of postoperative early supportive treatment of enteral and parenteral nutrition on early prognosis in patients with gastric carcinoma after radical gastrectomy. Methods A total of 80 patients undergoing radical gastrectomy during March 2016 and September 2017 were divided into control group and observation group(n=40 in each group) according to different nutritional treatments. Control group was treated with supportive treatment of parenteral nutrition only, while observation group was treated with supportive treatment of enteral and parenteral nutrition. In two groups, indexes of cellular immunity and humoral immunity on the 1~(st) d and 7~(th) d after operation were compared; length of postoperative stay, exhaust time of anal canal, incidence rate of complications and mortality were compared. Results On the 7~(th) d after operation, proportion of CD3+ and CD4+ cells, ratio of CD4+/CD8+ and levels of IgA, IgG and IgM were increased compared with those on the 1~(st) d after operation in two groups, and the increasing values in observation group were more obvious than those in control group(P<0.05). On the 7~(th) d after operation, proportion of CD8+ cells were decreased compared with those on the 1~(st) d after operation in two groups, and the decreasing values in observation group were more obvious than those in control group(P<0.05). Length of postoperative stay, exhaust time of anal canal, anastomotic leakage, incidence rates of residual gastric atony and wound infection and mortality were lower in observation group than those in control group(P<0.05). Conclusion Postoperative early supportive treatment of enteral and parenteral nutrition is beneficial to improving immune function, shortening length of stay and reducing incidence rate of postoperative complications and mortality of patients with gastric carcinoma after radical gastrectomy.
Objective To investigate effect of postoperative early supportive treatment of enteral and parenteral nutrition on early prognosis in patients with gastric carcinoma after radical gastrectomy. Methods A total of 80 patients undergoing radical gastrectomy during March 2016 and September 2017 were divided into control group and observation group(n=40 in each group) according to different nutritional treatments. Control group was treated with supportive treatment of parenteral nutrition only, while observation group was treated with supportive treatment of enteral and parenteral nutrition. In two groups, indexes of cellular immunity and humoral immunity on the 1~(st) d and 7~(th) d after operation were compared; length of postoperative stay, exhaust time of anal canal, incidence rate of complications and mortality were compared. Results On the 7~(th) d after operation, proportion of CD3+ and CD4+ cells, ratio of CD4+/CD8+ and levels of IgA, IgG and IgM were increased compared with those on the 1~(st) d after operation in two groups, and the increasing values in observation group were more obvious than those in control group(P<0.05). On the 7~(th) d after operation, proportion of CD8+ cells were decreased compared with those on the 1~(st) d after operation in two groups, and the decreasing values in observation group were more obvious than those in control group(P<0.05). Length of postoperative stay, exhaust time of anal canal, anastomotic leakage, incidence rates of residual gastric atony and wound infection and mortality were lower in observation group than those in control group(P<0.05). Conclusion Postoperative early supportive treatment of enteral and parenteral nutrition is beneficial to improving immune function, shortening length of stay and reducing incidence rate of postoperative complications and mortality of patients with gastric carcinoma after radical gastrectomy.
引文
[1] 黄智清,张诚华,施建设,等.肠内免疫微生态营养支持对肝癌切除术后肝损害的影响[J].临床误诊误治,2016,29(2):92-96.
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[3] 黄喜顺,邓立新,邱耀辉,等.早期胃癌筛查血清学指标研究进展[J].临床误诊误治,2016,29(8):109-116.
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[9] 朱云龙.早期肠内营养对胃切除术后患者营养状态和肝功能及临床预后的影响[J].中国中西医结合消化杂志,2016,24(11):855-857,860.
[10] 李治刚.胃癌根治术后行早期肠内免疫营养支持促进机体胃肠、免疫功能恢复的临床研究[J].海南医学院学报,2016,22(10):988-991.
[11] 苍玉珍,曾青山,黄文静.胃癌手术后出院患者早期行肠内营养干预对其营养指标的影响[J].海南医学,2016,27(19):3170-3172.
[12] 王晶,聂莉,黎发海,等.行胃癌根治术的老年患者实施早期肠内营养支持对其外周血蛋白及细胞免疫水平的影响[J].检验医学与临床,2017,14(1):86-89.
[13] 马利剑,任明姬,田云鹏,等.大蒜素抗胃癌作用及其机制的探讨[J].医学分子生物学杂志,2016,13(3):183-186.
[14] 王馨,苏兆亮,许文林,等.miR-187在胃癌中的表达及其对胃癌细胞增殖和侵袭的影响[J].江苏大学学报:医学版,2017,27(5):391-396.
[15] 朱慧芳,王书奎.单核苷酸多态性与胃癌的关系研究进展[J].医学分子生物学杂志,2005,2(2):153-155.
[16] 张秋红.综合护理干预对胃癌患者营养不良状况及化疗依从性的影响[J].保健医学研究与实践,2016,13(5):74-75,77.
[17] 李倩,韩丁,姚俊英,等.胃癌患者术后肠内营养支持时机探讨[J].新疆医科大学学报,2016,39(11):1386-1388.
[18] 任春霞,黄维明.胃癌患者术前营养筛查对其围手术期营养状况及术后恢复的作用[J].肿瘤学杂志,2017,23(5):452-454.
[19] 张伟,朱维铭.晚期胃癌规范化营养支持治疗[J].中国实用外科志,2017,37(10):1118-1123.
[2] 金海龙,宋海瑚,刘浩,等.术前早期肠内营养对老年胃癌患者术后免疫功能及预后的影响[J].医学研究杂志,2016,45(12):130-133.
[3] 黄喜顺,邓立新,邱耀辉,等.早期胃癌筛查血清学指标研究进展[J].临床误诊误治,2016,29(8):109-116.
[4] 张泽.胃癌患者术后肠内外营养支持对其免疫功能和并发症的影响[J].实用癌症杂志,2016,31(8):1287-1289.
[5] 王丹,张丽莉,程晓娜,等.早期肠内营养或肠外营养治疗对胃癌根治术后患者免疫功能和营养状况的影响[J].临床肿瘤学杂志,2017,22(5):423-426.
[6] Heighes P T,Doig G S,Sweetman E A,et al.An overview of evidence from systematic reviews evaluating early enteral nutrition in critically ill patients:more convincing evidence is needed[J].Anaesth Intensive Care,2010,38(1):167-174.
[7] 高俊,邱秀娟,王琦三.营养风险筛查对胃癌手术并发症发生率的预测价值[J].中国肿瘤临床,2015,42(5):271-276.
[8] 杨兰,张霞.胃癌术后早期肠外联合肠内营养支持治疗的临床效果[J].西部医学,2017,29(11):1555-1559.
[9] 朱云龙.早期肠内营养对胃切除术后患者营养状态和肝功能及临床预后的影响[J].中国中西医结合消化杂志,2016,24(11):855-857,860.
[10] 李治刚.胃癌根治术后行早期肠内免疫营养支持促进机体胃肠、免疫功能恢复的临床研究[J].海南医学院学报,2016,22(10):988-991.
[11] 苍玉珍,曾青山,黄文静.胃癌手术后出院患者早期行肠内营养干预对其营养指标的影响[J].海南医学,2016,27(19):3170-3172.
[12] 王晶,聂莉,黎发海,等.行胃癌根治术的老年患者实施早期肠内营养支持对其外周血蛋白及细胞免疫水平的影响[J].检验医学与临床,2017,14(1):86-89.
[13] 马利剑,任明姬,田云鹏,等.大蒜素抗胃癌作用及其机制的探讨[J].医学分子生物学杂志,2016,13(3):183-186.
[14] 王馨,苏兆亮,许文林,等.miR-187在胃癌中的表达及其对胃癌细胞增殖和侵袭的影响[J].江苏大学学报:医学版,2017,27(5):391-396.
[15] 朱慧芳,王书奎.单核苷酸多态性与胃癌的关系研究进展[J].医学分子生物学杂志,2005,2(2):153-155.
[16] 张秋红.综合护理干预对胃癌患者营养不良状况及化疗依从性的影响[J].保健医学研究与实践,2016,13(5):74-75,77.
[17] 李倩,韩丁,姚俊英,等.胃癌患者术后肠内营养支持时机探讨[J].新疆医科大学学报,2016,39(11):1386-1388.
[18] 任春霞,黄维明.胃癌患者术前营养筛查对其围手术期营养状况及术后恢复的作用[J].肿瘤学杂志,2017,23(5):452-454.
[19] 张伟,朱维铭.晚期胃癌规范化营养支持治疗[J].中国实用外科志,2017,37(10):1118-1123.