摘要
目的观察早期进食肠内营养制剂对结直肠癌患者临床结局和免疫功能的影响。方法88例结直肠癌患者随机分为试验组（43例）和对照组（45例）。试验组术后早期少量多次进水和肠内营养制剂，对照组采用传统治疗方案。比较2组患者术前和术后第1、3、7天IgA、IgG、IgM以及CD4^＋、CD4^＋／CD8^＋和C-反应蛋白（C-reactive protien，CRP）水平，记录术后住院天数、并发症及生活质量等指标。结果试验组术后发热时间[（54±6）h比（65±6）h，t=8．688，P〈0．01]、排气时间[（58±8）h比（72±7）h，t=8．573，P〈0．01]、住院时间[（6．9±1．4）d比（8．5±1．9）d，t=4．277，P〈0．01]以及治疗费用[（41868±3168）元比（45950±3714）元，t=5．536，P〈0．01]明显少于对照组，差异有统计学意义，而2组术后并发症发生[18．6％（8／43）比22．2％（10／45），t=0．177，P〉0．05]相比差异无统计学意义；试验组出院时生活质量评分[（18．4±1．7）比（16．4±1．9），t=5．235，P〈0．01]明显高于对照组。术后第7天试验组CD4^＋、CD4^＋／CD8^＋和IgM水平明显高于对照组（t=3．639，t=2．255，t=2．119，P〈0．05）；术后第3天和第7天试验组IgA、IgG明显高于对照组（t=2．035，t=2．961，t=2．060，t=2．108，P〈0．05）；术后第3天和第7天试验组CRP水平明显低于对照组（t=7．308，t=3．435，P〈0．05）。结论术后早期进食肠内营养制剂能够改善结直肠癌患者免疫功能，降低应激反应、促进康复。
Objective To observe the effect of early enteral feeding on clinical outcomes and immune function in patients after colorectal cancer surgery. Methods 90 cases of colorectal cancer patients were randomly divided into early enteral feeding group （43 cases） and control group （45 cases）. Patients in early feeding group were given small amount of water several times and enteral nutrition early after surgery, while patients in the control group were administrated according to conventional postoperative care protocol. Data were collected on serum IgA, IgG, IgM, CD4 ^± , CD4^±/CD8 ^± and CRP on the postoperative first, third and seventh days, postoperative length of stay, complications and quality of life. Results The postoperative fever time [ （54 ± 6） h vs. （65 ± 6） h, t = 8. 688 , P 〈 0. O1 ], time to flatus [ （58 ~ 8） h vs. （72±7） h, t=8.573, P〈0.01], postoperative length of stay [（6.9±1.4） dvs. （8.5±1.9） d, t= 4. 277, P 〈 O. 01 ] and health care cost [ （41 868± 3 168） RMB vs. （45 950 ± 3 714） RMB, t = 5. 536,P 〈 O. 01 ] were significantly in favour of early enteral feeding group than those in control group. Further, the score of quality of life at discharge were significantly higher in early enteral feeding group [ （ 18.4 ± 1.7 ） vs. （ 16. 4 ± 1.9）, t = 5. 235, P 〈 O. 01 ], while the complication incidence showed no difference between the two groups [18.6% （8/43） vs. 22.2% （10/45）, t=0. 177, P〉0.05]. The CD4^＋ , CD4^＋/CD8^＋ and IgM on the seventh postoperative day and the IgA and IgG on the third and seventh postoperative day were significantly better in early enteral feeding group while the CRP was significantly lower as compared to the control group （ t = 3. 639, t = 2. 255,t = 2. 119, t = 2. 035, t = 2. 961, t = 2. 060,t = 2. 108, t = 7. 308,t = 3. 435 ,P 〈 0. 05 ）. Conclusions Early oral enteral feeding after elective colorectal cancer surgery can improve patient＇s immune function, reduce the stress and accelerate reha
出处
《中华普通外科杂志》
CSCD
北大核心
2015年第1期38-41,共4页
Chinese Journal of General Surgery
关键词
结直肠肿瘤
肠道营养
免疫功能
肠道功能
Colorectal neoplasms
Enteral nutrition
Immune function
Intestinal function
