【摘要】 目的探讨全胃切除患者围手术期免疫增强型肠内营养支持对机体营养状态,免疫功能及炎症反应的影响。方法选择进展期胃癌根治性全胃切除患者48例,随机分为两组:围手术期肠内营养组(实验组,24例)和术后肠内营养组(对照组,24例)。实验组术前5d及术后8d给予免疫增强型肠内营养剂,术前未行常规肠道准备。对照组只在术后给予8d,术前常规行肠道准备。两组患者于术前1d及术后第1天、第8天分别抽取外周血测定血清总蛋白、白蛋白、IgA、T淋巴细胞亚群(CD4、CD4/CD8)、CRP和TNF-α。结果术中见两组患者肠道清洁程度无显著性差异;实验组与对照组比较,实验组血清总蛋白、白蛋白水平较高,随着肠内营养的进行术后实验组增高的更加明显,但无统计学意义;术后实验组CRP、TNF-α水平逐渐降低且同期水平低于对照组,IgA、CD4、CD4/CD8比例逐渐增高且同期水平高于对照组,差异有显著统计学意义,P<0.05。结论全胃切除患者围手术期免疫增强型肠内营养支持可明显改善患者的营养状态,增强机体免疫功能,减轻机体炎症反应,促进机体恢复。更多还原

【Abstract】 Objective To investigate the effect of perioperative immunomodulating enteral nutrition(EN)support on nutritional status,immune function and inflammatory response of the patients who underwent total gastrectomy.Methods Fourty-eight patients who had undergone total radical gastrectomy were randomly divided into group A(n=24)and group B(n=24).In group A,enteral nutrition support was given for 5 days before operation and 8 days from six hours after operation by an oral or nose-gastric tube.In group A,all patients did not receive conventional intestinal preparation before operation.In group B,EN support was given for 8 days from six hours after operation by an oral or nose-gastric tube and they received conventional intestinal preparation before operation.The levels of total protein,albumin,IgA,CD4,CD4/CD8,CRP and TNF-α were measured on day-1,1 and 8 after operation.Results There was no significant difference in intestinal cleanliness between the two groups.Compared with group B,the levels of total protein and albumin were much higher in group A,and increased after operation,but there was no significant difference between the two groups.In group A,the postoperative levels of CRP and TNF-α decreased gradually and were much lower than those in group B(P<0.05).In group A,the postoperative levels of IgA,CD4 and CD4/CD8 increased gradually and were much higher than those in group B(P<0.05).Conclusion Perioperative immunomodulating enteral nutrition support could improve nutritional status,enhance immunity,reduce inflammatory response,and promote recovery.更多还原