【摘要】 目的 :比较肠内、肠外营养联合应用和单用肠外营养对消化道肿瘤病人术后营养状况和免疫功能的影响。方法 :40例消化道肿瘤病人随机分为肠内、肠外营养联合应用 (EN加PN)组和肠外营养 (PN)组 ,每组 2 0例。术后第一天开始给予等热量、等氮量的营养支持一周 ,并检测术前和术后第 8天的营养指标和免疫指标。结果 :两组病人术后第 8天的体重均较术前明显下降 ,两组间无差异 (P <0 .0 0 1)。两组病人血浆白蛋白水平在术后第 8天均明显下降 ,但EN加PN组较PN组下降幅度小 (P <0 .0 5 )。累计 7天氮平衡EN加PN组为 - 2 6 .1g± 15 .3g ,PN组为- 2 3.4g± 10 .3g ,组间无明显差异。EN加PN组CD3 、CD4 、CRP和IgM水平明显提高 ;PN组的NK细胞水平明显下降。结论 :消化道肿瘤病人在术后早期应激状态下 ,EN或PN均难以避免机体分解代谢状态。EN可以达到与PN类似的维持体重和氮平衡的临床疗效。在维持血浆白蛋白水平方面 ,EN优于PN。EN可改善T辅助细胞功能 ;而PN可能降低NK细胞水平。术后早期EN是安全、可行和有效的。更多还原

【Abstract】 Objective: To evaluate the effects of enteral nutrition(EN) and parenteral nutrition(PN) on nutritional status and immune function of patients following surgery for tumors of the digestive tract. Methods: Fourty patients operated for tumor of the alimentary tract were divided into EN+PN group (n=20) and PN group (n=20). Isocaloric and isonitrogenous nutritional support was performed from the first day after the operation and was maintained for one week. Parameters of nutritional and immunal statuses were measured before and after nutritional support. Results: Body weight decreased significantly in both groups, but without significant difference. The plasma albumin concentration decreased significantly after surgery in two groups and more significantly in PN group (P<0.05). The accumulated nitrogen balance is -26.1±15.3g in EN+PN group, and -23.4±10.3g in PN group, but without significant difference. Levels of CD 3,CD 4, CRP and IgM after nutritional support were higher in EN+PN group than those before the treatment. In PN group, the level of NK cells decreased significantly. Conclusions: In the status of stress in patients after surgery, neither EN nor PN can avoid catabolism. While producing similar effects on nitrogen balance, EN is superior to PN in terms of maintaining plasma albumin. EN could improve T-helper cell function and PN may lower the level of NK cell. Early EN after surgery is safe, feasible and effective.更多还原