存在营养风险的原发性肝癌患者术前营养支持的效果及对免疫功能的影响
摘要
目的研究存在营养风险的原发性肝癌(PLC)手术患者术前营养支持的必要性及其效果。方法选择我院2017年1月至2018年4月收治的存在营养风险的原发性肝癌手术患者138例作为研究对象,按照是否给予术前营养支持进行分组,给予术前营养支持的患者作为观察组,未给予术前营养支持的患者作为对照组,每组69例。观察分析两组患者术后的营养状况、免疫功能、术后恢复情况、不良反应以及疗效。结果观察组的总有效率为92.8%,显著高于对照组(79.7%,P<0.05);术后观察组患者术后的白蛋白(ALB)、前白蛋白(PAB)与血红蛋白(Hb)水平分别为(25.83±2.12) g/L、(192.52±42.45) mg/L、(90.42±12.65) g/L,高于对照组患者[(21.60±1.93) g/L、(165.41±36.46) mg/L、(70.40±8.34) g/L,P<0.05];观察组患者住院时间、首次排气时间、排便时间、留置胃管时间分别为(50.62±8.90) d、(61.81±7.22) h、(72.53±12.30) h、(28.83±3.72) h,明显低于对照组(64.20±9.21) d、(73.64±7.73) h、(120.32±13.71) h、(41.61±4.50) h,(P<0.05);观察组术后免疫功能指标IgA、IgG、CD4~+及CD3~+分别为(2.81±0.43) g/L、(8.22±0.70) g/L、(30.24±4.11)%、(58.12±5.64)%,明显高于对照组(2.04±0.22) g/L、(7.21±0.43) g/L、(27.12±3.54)%、(53.62±5.20)%,(P<0.05);观察组不良反应的发生率(11.59%)明显高于对照组不良反应的发生率(27.54%,P<0.05);观察组患者1年生存率(89.85%)明显高于对照组(76.81%,P<0.05),术前未给予营养支持、Child-Pugh B级、肿瘤直径≥5 cm、TNMⅢ～Ⅳ期、存在血管侵犯及淋巴结转移为PLC患者术后生存预后的独立影响因素。结论对于存在营养风险的原发性肝癌手术患者而言,给予术前营养支持能有效改善营养状况及免疫功能,加快术后恢复,减少不良反应,对患者康复具有辅助作用。
引文
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[3] Aguilera XP, González C, Nájera-De Ferrari M, et al. Tuberculosis in prisoners and their contacts in Chile: estimating incidence and latent infection. Int J Tuberc Lung Dis, 2016, 20:63-70.
[4] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版). 中华消化外科杂志, 2017, 16:705-720.
[5] 王治冲,宋风斌.失代偿期乙型肝炎肝硬化患者营养状况分析. 实用肝脏病杂志, 2017, 20: 236-237.
[6] Deas E, Cremades N, Angelova PR, et al. Alpha-synuclein oligomers interact with metal ions to induce oxidative stress and neuronal death in parkinson′s disease. Antioxid Redox Signal, 2016, 24:376-391.
[7] Joosten KF, Kerklaan D, Verbruggen SC. Nutritional support and the role of the stress response in critically ill children. Curr Opin Clin Nutr Metab Care, 2016, 19:226-233.
[8] 张赫, 邹寒冰, 刘喆,等. 50例肝癌患者外周血淋巴细胞亚群比例与肝功能损伤的关系. 肝脏, 2017, 22:994-997.
[9] Lee JL, Oh ES, Lee RW, et al. Serum albumin and prealbumin in calorically restricted, nondiseased individuals: A systematic review. Am J Med, 2015, 128: 1-22.