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目的:探讨含克林诺脂肪乳剂的全肠外营养(TPN)及含中长链脂肪乳剂的TPN对食管癌患者术后免疫功能的影响。方法:43例食管癌手术患者随机分成两组,一组术后给予7d以上的含脂肪乳剂克林诺的TPN,另外一组则给予7d以上含中长链脂肪乳剂中长链脂肪乳的TPN。检测各患者术前1d,术后1d,术后8d免疫球蛋白5项及淋巴细胞计数及亚群,采用t检验或秩和检验进行统计学分析。结果:两组患者术后第1d的淋巴细胞、IgA、IgG、IgM、CD8+等较术前1d均有明显下降;术后8d的IgA、IgG、IgM、C3等较术后1d均有明显上升;术后8d和术后1d的变化两组间相比,克林诺组IgG升高更明显;术后8d和术前1d的变化两组间相比,克林诺组的IgG,IgM较术前升高更明显。结论:手术明显降低食管癌患者机体的细胞免疫和体液免疫功能;行7d的含脂肪乳剂的TPN可明显的促进食管癌患者体液免疫功能恢复,而对细胞免疫无影响;与中长链脂肪乳相比,含克林诺的TPN可能更有利于促进食管癌患者术后机体免疫功能的恢复。
Objective: To investigate the effect of total parenteral nutrition (TPN) containing staple fat emulsion and TPN containing long-chain fat emulsion on postoperative immune function in esophageal cancer patients. Methods: Forty-three patients undergoing esophageal cancer surgery were randomly divided into two groups. One group received more than 7 days of TPN containing fat emulsion and the other group received TPN containing medium-long-chain fat emulsion for more than 7 days. . The patients’ preoperative 1d, postoperative 1d, postoperative 8d immunoglobulin 5 and lymphocyte count and subpopulation were detected by t test or rank sum test for statistical analysis. Results: The levels of lymphocytes, IgA, IgG, IgM and CD8 + on the first postoperative day in the two groups were significantly lower than those on the first postoperative day. The levels of IgA, IgG, IgM and C3 on the 8th postoperative day were significantly higher than those on the 1st postoperative day ; Postoperative 8d and postoperative 1d changes between the two groups compared to the Ke Lino group IgG increased significantly; postoperative 8d and preoperative 1d changes between the two groups compared to the Ke Lino group IgG, IgM Preoperative increase more pronounced. CONCLUSIONS: The surgery significantly reduced cellular and humoral immune function in esophageal cancer patients. The TPN containing fat emulsion for 7 days significantly promoted the recovery of humoral immune function in esophageal cancer patients without any effect on cellular immunity. In contrast, TPN containing Kellinox may be more conducive to the recovery of postoperative esophageal cancer immune function.