摘要
目的：探讨术前合理的营养支持对胃癌及结直肠癌患者术后恢复的影响．方法：消化道恶性肿瘤手术并存在营养不良的患者69例,分为肠外营养组(PN组,24例)、肠内肠外营养结合组(EN-PN组,23例)和常规治疗组(NN组,22例),PN组和EN-PN组均于术前7d开始营养治疗,3组患者均于术后24 h开始肠内和肠外相结合的营养方式．分别于术前7d和术后7d测定血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)、血清内毒素水平及细胞因子IL-6、TNFα,测定血清IgA,IgG,IgM,NK细胞活性及CD4/CD8值评价免疫功能,比较3组患者并发症的发生率及平均住院时间．结果：EN-PN组在术后7 d血清内毒素水平(4．23±2．01 ng/L)、IL-6(40．22±7．43 ng/L)及TNF-α(33．04±4．56 ng/L)均明显低于PN(分别为8．23±3．65,55．21±9．32,47．22±8．45 ng/L,P＜0．01)和NN组(10．66±5．23,67．01±10．21,56．43±9．67,ng/L P＜0．01)．而EN-PN组在术后7 d PA(0．27±0．06 g/L),TFN(2．81±0．65 g/L),IgG(10．43±0．86 g/L),NK细胞活性(18．04%±4．56%)及CD4/CD8值(4．98±1．21)明显高于PN组(分别为0．19±0．04,2．01±0．32,8．76±0．65 g/L,11．01%±3．01%,2．11±0．65,P＜0．05)和NN组(分别为0．15±0．03,1．32±0．27,9．05±0．79 g/L,6．45%±2．23%,1．22±0．79,P＜0．05)．与PN和NN组相比,患者并发症发生率(11．3% vs 16．4%,21．6%)和住院时间(7．0±1．4d vs 11．0±2．4,13．0±2．8 d)EN-PN组亦明显降低(P＜0．01)．结论：存在营养不良的消化道恶性肿瘤患者术前应用肠内和肠外营养相结合的营养方式是安全有效的,可促进患者恢复．
AIM： To investigate the effects of pre-operative enteral and parenteral nutrition （EN-PN） on the malnourished gastrointestinal cancer patients.
METHODS： Sixty-nine malnutritional patients with gastrointestinal cancer were randomly divided into 3 groups： EN-PN group （n=23）, parenteral nutrition group （PN, n= 24） and nonnutrition group （NN, n= 2）. EN-PN and PN group were received nutritional support of the same nitrogen and calorie 7 d before operation. Each group received the same nutritional support （EN-PN） 24 h after operation. The levels of serum albumin （ALB）, pre-albumin （PA）, transferrin （TFN）, endotoxin （ET）, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α） were detected 7 d before and after operation. The levels of serum IgA, IgG and IgM, the activity of natural killer （NK） cells and the ratio of CD4 to CD8 （CD4/CD8） were measured to evaluate the immune function of the patients. The incidence rate of complications and mean hospitalized time were compared between the three groups.
RESULTS： After operation, the levels of serum PA （0.27±0.06 g/L）, TFN （2.81±0.65 g/L） and IgG （10.43±0.86 g/L）, the activity of NK cells （18.04%±4.56%） and the value of CD4/CD8 （4.98±1.21） were significantly higher in EN-PN group than those in PN （0.19±0.04, 2.01±0.32, 8.76±0.65 g/L, 11.01%± 3.01%, 2.11±0.65, respectively, P〈0.05） and NN group （0.15±0.03, 1.32±0.27, 9.05±0.79 g/L, 6.45%±2.23%, 1.22±0.79, respectively, P〈0.05）, but the levels of serum ET （4.23±2.01 ng/L）, IL-6 （40.22±7.43 ng/L） and TNF-α （33.04±4.56 ng/L） markedly lower than those in PN （8.23±3.65, 55.21±9.32, 47.22±8.45 ng/L, respectively, P〈0.01） and NN group （10.66±5.23, 67.01±10.21, 56.43±9.67 ng/L, respectively, P 〈 0.01）. In comparison with those in PN and NN group, the incidence rate of complications （11.3% vs 16.4%, 21.6%） and mean hospitalized time （7.0 ±1.4 d vs 11.0 ±2.4, 13.0± 2.8 d） were also
出处
《世界华人消化杂志》
CAS
北大核心
2006年第19期1928-1932,共5页
World Chinese Journal of Digestology
关键词
肠内营养
肠外营养
消化道肿瘤
术前
Enteral nutrition
Parenteral nutrition
Gastrointestinal cancer
Preoperation
