摘要
目的:探讨不同营养方式对胃癌患者术后机体免疫功能,营养状况,肝肾功能,肠功能的影响。方法:选取我院2006年2月～12月胃癌根治性手术病人60例,随机分为两组:早期肠内营养组30例,于术后24h应用瑞素行早期肠内营养,共实施7天;完全肠外营养组30例,术后给予常规输液治疗。两组病人分别于手术前1天、术后第1天与第8天检测免疫指标,营养指标,肝肾功能指标,并观察肠功能恢复时间。结果:(1)术后第1天两组病人IgA、IgG、IgM、CD3~+、CD4~+、CD4~+/CD8~+比值均较术前有所下降,而术后第8天早期肠内营养组IgA、IgG、IgM、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+等免疫指标迅速恢复,与完全肠外营养组比较差异显著(P＜0.05);(2)术后第一天患者血清清蛋白(ALB),转铁蛋白(TF)和前清蛋白(PA)浓度较术前有明显下降(P＜0.05,P＜0.05,P＜0.01),经一段时期的肠内营养和肠外营养支持后基本恢复到术前水平,肠内营养的营养恢复作用与肠外营养相比无明显差异;(3)术后患者血清直接胆红素、间接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血肌酐、尿素氮,两组病人无明显差异(P＞0.05);(4)肛门排气/排便时间两组病人差异显著(P＜0.01)。经肠内营养和肠外营养支持后,两组病人在观察期间均无严重并发症发生。结论:术后早期肠内营养支持可以改善胃癌病人的营养状况,其增强机体免疫功能,促进肠蠕动恢复的作用优于肠外营养。
Objectives:To Investigate immune function,nutritional status,function of liver and kidney,bowel function effect of early enteral nutrition in surgical patients with gastric cancer.Methods:Sixty patients were obtained from gastric cancer in 2006.and randomly divided into EEN group and PN group.The patients in EEN group received Fresubin early enteral nutrition from postoperative day 1 to postoperative day 7.The patients in PN group received total parental nutrition.IgA,IgG,IgM,CD3~+,CD4~+,CD8~+, CD4~+/CD8~+,ALB,PA,PF,UCB,CB,ALT,AST,CREAT,BUN were detected on the day before the operation and the postoperative days 1 and 8.And the restoring time of intestinal movement was observed.Results:(1)As compared with the day before the operation,all the levels of IgA,IgG,IgM,CD3~+,CD4~+ and CD4~+/CD8~+ in two groups were decreased on the 1 day postoperatively.However,the changes in the EN group was significantly different from PN group on the 8 day postoperatively(P＜0.05).(2)On the 1 day postoperatively,ALB,PA,TF in tow groups decreased significantly(P＜0.05,P＜0.05, P＜0.01).On the 8th day,there were no significant differentce in ALB,PA,PF in EN-group than in PN-group(P＞0.05).(3)No significant differences existed between these two groups in UCB,CB,ALT,AST,CREAT,BUN before operation and on the 1,8day postoperatively(P＞0.05).(4)The restoring time of bowel movement was significantly decreased in the EN group compared with PN group after operation(P＜0.01).In both EEN group and PN group there were no serious complications.Conclusions:Early enteral nutrition can improve nutritional status,and compared with the parenteral nutrition, EEN can enhance obviousely immune function and promote the recovery of bowel function in gastric cancer surgical patients.
引文
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