【作者】 王琦三；

【导师】 王海江；

【作者基本信息】 新疆医科大学 ， 肿瘤学， 2007， 硕士

【摘要】 目的:探讨不同营养方式对胃癌患者术后机体免疫功能,营养状况,肝肾功能,肠功能的影响。方法:选取我院2006年2月～12月胃癌根治性手术病人60例,随机分为两组:早期肠内营养组30例,于术后24h应用瑞素行早期肠内营养,共实施7天;完全肠外营养组30例,术后给予常规输液治疗。两组病人分别于手术前1天、术后第1天与第8天检测免疫指标,营养指标,肝肾功能指标,并观察肠功能恢复时间。结果:(1)术后第1天两组病人IgA、IgG、IgM、CD3~+、CD4~+、CD4~+/CD8~+比值均较术前有所下降,而术后第8天早期肠内营养组IgA、IgG、IgM、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+等免疫指标迅速恢复,与完全肠外营养组比较差异显著(P＜0.05);(2)术后第一天患者血清清蛋白(ALB),转铁蛋白(TF)和前清蛋白(PA)浓度较术前有明显下降(P＜0.05,P＜0.05,P＜0.01),经一段时期的肠内营养和肠外营养支持后基本恢复到术前水平,肠内营养的营养恢复作用与肠外营养相比无明显差异;(3)术后患者血清直接胆红素、间接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血肌酐、尿素氮,两组病人无明显差异(P＞0.05);(4)肛门排气/排便时间两组病人差异显著(P＜0.01)。经肠内营养和肠外营养支持后,两组病人在观察期间均无严重并发症发生。结论:术后早期肠内营养支持可以改善胃癌病人的营养状况,其增强机体免疫功能,促进肠蠕动恢复的作用优于肠外营养。更多还原

【Abstract】 Objectives:To Investigate immune function,nutritional status,function of liver and kidney,bowel function effect of early enteral nutrition in surgical patients with gastric cancer.Methods:Sixty patients were obtained from gastric cancer in 2006.and randomly divided into EEN group and PN group.The patients in EEN group received Fresubin early enteral nutrition from postoperative day 1 to postoperative day 7.The patients in PN group received total parental nutrition.IgA,IgG,IgM,CD3~+,CD4~+,CD8~+, CD4~+/CD8~+,ALB,PA,PF,UCB,CB,ALT,AST,CREAT,BUN were detected on the day before the operation and the postoperative days 1 and 8.And the restoring time of intestinal movement was observed.Results:(1)As compared with the day before the operation,all the levels of IgA,IgG,IgM,CD3~+,CD4~+ and CD4~+/CD8~+ in two groups were decreased on the 1 day postoperatively.However,the changes in the EN group was significantly different from PN group on the 8 day postoperatively(P＜0.05).(2)On the 1 day postoperatively,ALB,PA,TF in tow groups decreased significantly(P＜0.05,P＜0.05, P＜0.01).On the 8th day,there were no significant differentce in ALB,PA,PF in EN-group than in PN-group(P＞0.05).(3)No significant differences existed between these two groups in UCB,CB,ALT,AST,CREAT,BUN before operation and on the 1,8day postoperatively(P＞0.05).(4)The restoring time of bowel movement was significantly decreased in the EN group compared with PN group after operation(P＜0.01).In both EEN group and PN group there were no serious complications.Conclusions:Early enteral nutrition can improve nutritional status,and compared with the parenteral nutrition, EEN can enhance obviousely immune function and promote the recovery of bowel function in gastric cancer surgical patients.更多还原