胃肠癌术后早期应用肠内营养的作用

Effect of Postoperative Early Enteral Nutrition on the Patients with Gastrointestinal Carcinoma

目的 :比较早期肠内与肠外营养对胃肠癌术后患者免疫和营养状况的影响。方法 :72例胃肠癌患者随机分为肠内营养组 (EN组 )和肠外营养组 (PN组 )各 2 6例及常规输液组 (对照组 ) 2 0例。术后 2 4h开始肠内或肠外营养 ,检测术前和术后第 9天营养状况、免疫指标、严重并发症及肠功能恢复等情况。结果 :术后EN组、PN组体重、前白蛋白、白蛋白、免疫球蛋白等均显著高于对照组 (P <0 .0 5 ) ,而EN组与PN组间比较差异无显著性 ;术后CD3+ 、CD 4 + 、CD 4 + /CD8+ EN组、PN组均显著高于对照组 (P <0 .0 1) ,其中CD 4 + 、CD 4 + /CD 8+ EN组亦显著高于PN组 (P <0 .0 5 ) ;EN组胃肠功能恢复时间明显短于PN组和对照组 (P <0 .0 0 1)。结论 :早期肠内营养可明显改善胃肠癌术后近期的营养和免疫状况 ,肠功能恢复方面亦明显优于肠外营养。

Objective: To compare the effect of early enteral and parenteral nutrition on immune and nutritional statuses of patients after surgery for gastrointestinal carcinoma. Methods: 72 patients were randomly divided into enteral (EN, n =26), parenteral (PN, n =26) and control ( n =20) group. Patients in EN and PN group were subjected to nutrition support at 24 h after operation. Nutritional and immune parameters were detected on the day before operation and the 9th day after operation. Complications and recovery of intestinal movement were observed. Results: The postoperative levels of BW, PA, Alb, IgG, IgM and IgA in EN or PN group were significantly higher than those in control group( P <0.05), but there was no significant difference between EN and PN groups. The postoperative percentage of CD3 + ,CD4 + ,CD4 + /CD8 + in EN or PN group was significantly higher than that in control group( P <0.01). Moreover, the postoperative level of CD4 + , CD4 + /CD8 + in EN group was higher than that in PN group( P <0.05). The recovery time of intestinal movement was significantly shortened in EN group as compared with PN or control group( P <0.001). Conclusion: Early enteral nutrition can improve nutritional and immune statuses of postoperative patients with gastrointestinal carcinoma and is better than parenteral nutrition in recovery of intestinal movement.