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目的探讨早期肠内免疫营养对胃癌伴营养风险患者术后营养状态和免疫功能的影响。方法将2014年2~12月期间四川大学华西医院胃肠外科新入院胃癌患者运用NRS 2002进行营养风险筛查,将评分在3~5分的患者随机分为试验组(术后早期给予含谷氨酰胺的肠内营养,30例)和对照组(术后早期给予普通肠内营养,30例),两组术后给予7d营养支持。两组患者分别于术前1天和术后第3、7天空腹采集外周静脉血,用于检测细胞免疫指标(CD3~+、CD4~+、CD8~+和CD4~+/CD8~+比值)、营养状态指标(血浆转铁蛋白、前白蛋白、白蛋白水平)。同时观察记录术后首次肛门排气时间、术后住院期间肺部感染、炎性肠梗阻、术后住院时间等。结果术后第3天和术后第7天试验组患者CD4~+/CD8~+、转铁蛋白、血浆前白蛋白、白蛋白水平均高于对照组,差异有统计学意义(P<0.05)。与对照组相比,试验组患者术后肛门首次排气时间提前[(63.5±7.3)h vs.(72.8±8.6)h],差异有统计学意义(P<0.05)。但肺部感染、吻合口瘘、严重腹胀、炎性肠梗阻等方面,组间差异无统计学意义(P>0.05)。结论早期肠内免疫营养促进了胃癌伴营养风险患者术后免疫功能的恢复和血清前白蛋白、白蛋白水平的回升,促进了患者术后肠道功能的恢复和术后的康复。
Objective To investigate the effect of early enteral immunonutrition on nutritional status and immune function in gastric cancer patients with nutrition risk. Methods The patients with gastric cancer admitted to Huaxi Hospital of Sichuan University from February 2014 to December 2014 were enrolled in the study. Nutritional risk screening was conducted using NRS 2002. Patients with scores of 3 to 5 were randomly divided into experimental group (N = 30) and control group (n = 30). The patients in the two groups were given nutritional support after 7 days. Peripheral venous blood was collected one day before surgery and on the 3rd and 7th day after operation in both groups for the detection of cellular immune markers (CD3 +, CD4 +, CD8 + and CD4 + / CD8 + ratio ), Nutritional status indicators (plasma transferrin, prealbumin, albumin levels). At the same time, the time of the first anal exhaust, the pulmonary infection during hospitalization, inflammatory bowel obstruction, postoperative hospital stay and so on were recorded and recorded. Results The levels of CD4 ~ + / CD8 ~ +, transferrin, plasma prealbumin and albumin in the experimental group were significantly higher than those in the control group on the 3rd postoperative day and the 7th postoperative day (P <0.05 ). Compared with the control group, the first postoperative anal exhaust time of the experimental group was significantly earlier than that of the control group [(63.5 ± 7.3) h vs. (72.8 ± 8.6) h], the difference was statistically significant (P <0.05). However, there were no significant differences between the two groups in terms of pulmonary infection, anastomotic fistula, severe bloating and inflammatory bowel obstruction (P> 0.05). Conclusion Early enteral immunonutrition promotes the recovery of immune function and the recovery of prealbumin and albumin levels in postoperative patients with gastric cancer associated with nutritional risk, and promotes the recovery of postoperative intestinal function and postoperative recovery.