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目的:本研究旨在探讨存在营养风险的胃癌患者根治术后应激期采用低氮低热量(HNHC)及谷氨酰胺强化的低氮低热量(GEHN)营养支持方案的临床应用价值。方法:NRS评分(3～5分)的胃癌患者89例,随机分为3组。术后分别给予传统热氮量支持方案(TPN)、HNHC及GEHN 6天。监测血糖水平,营养指标,免疫指标,及术后恢复情况。结果:(1).术后血糖水平HNHC组的明显优于TPN组,在术后第1、2、3天组间差异有统计学显著性意义。(2).术后短期三组均存在负氮平衡,HNHC与TPN组比较各营养指标变化情况无统计学差异。HNHC与GEHN组比较:术前1天至术后第3天,转铁蛋白的下降幅度GEHN组明显低于于HNHC组;术后第3天至第6天、术前1天至术后第6天,GEHN中四种蛋白回升幅度明显大于HNHC,差异均存在统计学意义。(3).术后三组免疫指标,TPN组与HNHC组无统计学显著性差异,GEHN组有优于前两组的倾向,其中CD3变化存在统计学差异。(4).SIRS的发生数HNHC组少于TPN组,GEHN组术后排气时间明显较HNHC组快。结论:与传统TPN相比,HNHC在存在术前营养风险的胃癌患者术后应激期短期应用安全可行。HNHC方案术后应激期血糖水平稳定,全身炎症反应综合症低。GEHN方案能有效改善术后氮平衡、提高免疫水平、缩短肠蠕动恢复时间。GEHN是值得临床推广的术后应激期肠外营养支持方案。
OBJECTIVE: This study was designed to investigate the clinical value of low-nitrogen, low-calorie (HNHC) and glutamine-enhanced low-nitrogen and low-calorie (GEHN) nutritional support for patients with gastric cancer at nutritional risk. Methods: 89 patients with gastric cancer with NRS score (3-5) were randomly divided into 3 groups. The patients were given traditional TPN, HNHC and GEHN respectively for 6 days after operation. Monitoring blood glucose levels, nutritional indicators, immune indicators, and postoperative recovery. Results: (1) Postoperative blood glucose levels in HNHC group were significantly better than those in TPN group. There was a statistically significant difference between the two groups at the first, second and third days after operation. (2) There was a negative nitrogen balance in all three groups shortly after operation, and there was no significant difference in the changes of nutritional indexes between HNHC and TPN groups. HNHC and GEHN group: 1 day before surgery to 3 days after surgery, the decrease in transferrin in GEHN group was significantly lower than in HNHC group; 3 days to 6 days after surgery, 1 day before surgery to postoperative In 6 days, the recovery of four proteins in GEHN was significantly greater than that in HNHC, the differences were statistically significant. (3) After the three groups of immune indicators, TPN group and HNHC group no statistically significant difference, GEHN group is superior to the former two groups of tendencies, including CD3 changes there is a statistically significant difference. (4) The incidence of SIRS HNHC group less than the TPN group, GEHN group postoperative exhaust time was significantly faster than the HNHC group. Conclusion: Compared with the traditional TPN, HNHC is safe and feasible in short-term post-operative stress response in gastric cancer patients with preoperative nutritional risk. HNHC program postoperative stress blood glucose levels stable, systemic inflammatory response syndrome is low. GEHN program can effectively improve the postoperative nitrogen balance, improve the immune level and shorten the recovery time of peristalsis. GEHN is worthy of clinical promotion of postoperative stress parenteral nutrition support programs.