摘要
目的 :评价免疫增强型肠内营养制剂对肿瘤病人手术创伤后代谢、炎症反应、免疫功能及预后的影响。 方法 :88例消化道恶性肿瘤手术病人随机分为常规肠内营养组 (对照组 )和免疫增强型肠内营养组 (研究组 )。手术后第 1天开始等热量、等氮肠内营养支持 1周。于术前、术后第 1、4天和研究结束时分别检测免疫、炎症反应及营养指标。 结果 :研究结束时 ,研究组多数免疫指标均明显高于对照组 (P <0 .0 1) ;而血IL 6、TNF α浓度及CRP水平则明显低于对照组 (P <0 .0 5 )。研究期间两组白蛋白、每天及累积氮平衡无显著差异 ,术后第 8天 ,研究组血浆前白蛋白、转铁蛋白浓度明显高于对照组。研究组术后 4天以后的感染性并发症发生率明显低于对照组 ,平均住院时间也明显低于对照组。 结论 :免疫增强型肠内营养制剂可减轻肿瘤病人手术创伤后的应激和炎症反应程度 ,增强机体免疫功能 。
Objectives:To evaluate if the administration of an enteral diet supplemented with glutamine,arginine and ω 3 fatty acids modulate the inflammatory and immune responses and the outcome after surgery. Methods:A prospective,randomized,double blind and clinical trial was performed.Eighty eight patients with gastrointestinal cancer were randomly divided itnto two groups.One group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and ω 3 fatty acids.Feedings were started within 48 hour after operation, and continued until day 8.All variables were measured before operation and on postoperative day 1,4 and 8.Blood was drawn at different time points to assess albumin, prealbumin and transferring.Immune responses was determined by phagocytosis ability,respiratory burst of polymorphonuclear cells, total lymphocytes, lymphocyte subsets, nitric oxide,cytokine concentration,immunoglobins,and inflammatory responses by plasma levels of C reactive protein and prostaglandin E 2. Results:Tolerance of both formula diets was excellent.There were significant differences in the immunological and inflammatory responses between the two groups.In supplemented group,the serum concentrations of IgA,IgG,IgM,phagocytosis and respiratory burst after surgery were higher and C reactive protein level was lower( P <0.01) than in the standard group.The supplemented group had higher levels of nitric oxide,total lymphocytes, T lymphocytes and T helper cells.Postoperative levels of IL 6 and TNF α were lower in the supplemented group( P <0.05). Conclusions:It is clearly established in this trial that early postoperative enteral feeding may be accomplished safely in patients who have undergone major operations for gastrointestinal cancer.Supplementation of enteral immunonutrition can positively modulate the postsurgical immunosuppressive and inflammatory responses.
出处
《肠外与肠内营养》
CAS
2003年第1期8-11,14,共5页
Parenteral & Enteral Nutrition
