【作者】 蔡青山；

【导师】 王炜； 朴文花；

【作者基本信息】 宁夏医科大学 ， 外科学， 2010， 硕士

【摘要】 目的评价早期肠内营养(early enteral nutrition, EEN)与肠外营养(parenteral nutrition, PN)对进展期胃癌术后患者的支持效果。方法将40例进展期胃癌患者随机分为EEN组(n=20)与PN组(n=20)。EEN组患者,术后24h开始经鼻肠营养管予以肠内营养液—整蛋白型肠内营养乳剂;PN组患者,术后24h开始经锁骨下静脉给予肠外营养,两组患者术后营养支持均为7天。两组患者分别于术前1天和术后第8天晨起静脉采血检测:①营养指标,包括总蛋白(TP)、白蛋白(ALB)和前白蛋白(PA);②体液免疫指标,包括免疫球蛋白A(IgA)、免疫球蛋白M(IgM)和免疫球蛋白G(IgG);③细胞免疫指标,包括CD3+、CD4+、CD8+和CD4+/CD8+,并观察两组患者术后临床支持效果(肛门排气时间、不良反应和并发症发生率)和住院期间营养相关费用。结果所有患者在研究过程中未发生严重并发症或死亡。两组患者术前1天所有检测指标水平无明显差异。与术前1天相比,术后第8天EEN组CD4+和CD4+/CD8+水平明显升高,差异具有统计学意义(P<0.05),其余检测指标无显著性差异。同时,EEN组术后第8天IgA、CD4+和CD4+/CD8+恢复程度(改变量)显著高于PN组,差异具有统计学意义(P<0.05)。EEN组术后第8天PA、ALB和TP水平恢复程度(改变量)好于PN组,但是未达到显著差异(P>0.05)。EEN组和PN组出现不良反应的分别有5例和4例,发生率分别为25%和20%;EEN组和PN组分别有1例和4例发生感染性并发症,发生率分别为5%和20%。两组患者在肛门排气时间及营养相关费用方面,EEN组明显优于PN组,差异具有统计学意义(P<0.05)。结论与PN相比,EEN对进展期胃癌患者术后的营养支持方面有较明显的优势:能够提早恢复肠道功能,显著改善机体的营养状况,更好地恢复机体的免疫功能,明显降低术后感染性并发症的发生率和住院期间营养相关费用。因此,EEN是一种安全、有效、经济的营养补给方法,是进展期胃癌患者术后早期首选的营养支持方法。更多还原

【Abstract】 Objective To evaluate the effects of early enteral nutrition (EEN) and parenteral nutrition (PN) on patients with advanced gastric carcinoma after operation.Methods Forty patients with advanced gastric carcinoma were randomly divided into EEN group (n=20) and PN group (n=20). Patients of EEN group received Intacted Protein Enteral Nutrition by nose- duodenum tube at 24th hour after operation, those of PN group received parenteral nutrition by subclavian vein, nutritional support were all maintained 7 days. Nutritional variables including total protein (TP), albumin (ALB), pre-albumin (PA); humoral immunity parameters including IgG, IgM and IgA; cell immunity parameters including CD3+, CD4+ and CD4+/CD8+ were measured on preoperative 1st day and postoperative 8th day by collecting early morning venous blood. Meanwhile, the clinical effects, the time of passage of gas by anus, incidence rate of adverse reaction,complication and nutrition-related costs were also observed.Results All patients in the course of the study with no serious complications or death. There was no significant difference between the two groups of all variables on preoperative 1st day. Compared with preoperative 1st day, the levels of CD4+ and CD4+/CD8+ in the EEN group on the postoperative 8th day were significantly higher (P<0.05), and the other parameters showed no significant difference. At the same time, on the postoperative 8th day, the recovery levels of IgA, CD4+ and CD4+/CD8+ in the EEN group were significantly higher than that in PN group (P<0.05). Mean while the recovery levels of PA, ALB and TP in the EN group were higher than that in PN group (P>0.05). Patients with adverse reactions in the EEN group were 5 cases and 4 cases in the PN group, the incidence rates were 25% and 20%;Patients with infectious complications in the EEN group were 1 cases and 4 cases in the PN group, the incidence rates were 5% and 20%. Compared with PN group, the time of passage of gas by anus and nutrition-related costs in the EN group was significantly decreased (P<0.05).Conclusions Compared with PN supplements, EEN supplements for advanced gastric cancer patients after operation have more obvious advantage: restoring gastrointestinal tract function earlier, efficiently ameliorating the nutrition state, restoring the immune function, decreasing the postoperative incidence of infectious complications and nutrition-related costs. Therefore, EEN is a safe, effective and economical method of nutritional supplements and it is a preferred method of nutritional support for patients with advanced gastric carcinoma after operation at prophase.更多还原