胃肠道肿瘤患者术前肠内免疫营养支持

Preoperative enteral immunonutrition in patients with gastrointestinal cancer

目的 探讨胃肠道肿瘤术前应用免疫肠内营养对提高患者术后营养状况和免疫状态的作用,评价其对术后并发症和感染的影响,以及是否可减少术后平均住院天数。方法 选取 60例行胃肠道肿瘤手术的患者,随机分为 2组,实验组 (EN组 )术前 7天予含精氨酸、RNA和ω 3多不饱和脂肪酸的肠内免疫营养支持,对照组(CONT组)术前常规饮食准备。观察术前和术后营养和免疫指标,以及术后并发症、感染的发生人次和术后平均住院天数。结果 EN组术前营养状况和免疫指标与对照组相比差异无统计学意义。CONT组术后第 3天血清前白蛋白(PALB)和转铁蛋白(TRF)水平明显低于术前(P<0. 01),术后第 7天TRF水平仍明显低于术前。而EN组仅术后第 3天PALB明显低于术前,其余与术前比较差异无统计学意义,且术后第 7天PALB水平明显高于CONT组 (P<0. 05)。CONT组术后补体水平明显低于术前。EN组术后补体水平与术前比较差异无统计学意义,明显高于CONT组 (P<0. 05);术后IgG水平明显高于CONT组 [ ( 13. 35±2. 06 )g/L比 ( 9. 59±2. 23 )g/L,P<0. 05 ],术后CD4 /CD8比值明显高于CONT组(2. 10±0. 51比 1. 62±0. 52)。EN组术后并发症和感染的发生率明显低于CONT组,平均术后住院天数明显下降。

Objective To study the effect of preoperative immunonutrition on nutritional status and immunity for the patients with gastrointestinal cancer, and to evaluate whether the administration of immunonutrition could reduce the rate of postoperative complication and thus shorten the days of postoperative hospitalization. Methods Sixty patients with different gastrointestinal cancer were randomized to receive either immunonutrition (containing Arginine, RNA and ω-3 polyunsaturated fatty acids) for 7 days before surgery (EN, n=30) or a conventional diet (CONT, n=30). Variables of nutritional status and immunity, postoperative complications, infection and the days of postoperative hospitalization were measured. Results There were no significant differences in the immunological and nutritional variables between two groups before surgery. The serum concentrations of prealbumin(PALB) and transferrin(TRF) were lower than those before surgery in the CONT group on postoperative day 3 (P<0.01). TRF level was still significantly lower than that before surgery in the CONT group on postoperative day 7. PALB level was significantly lower than that before surgery in the EN group on postoperative day 3. Levels of PALB and TRF in EN group were significantly higher than those in CONT group on postoperative day 7(P<0.05). The level of alexin was significantly lower than that before surgery in CONT group while there were no significant postoperative changes in EN group, and also significantly higher than that in CONT group (P<0.05). Postoperative IgG level in EN group was higher than that in CONT group[(13.35±2.06) g/L vs (9.59±2.23) g/L, P<0.05]. CD4/CD8 ratio was significantly higher in EN group than that in CONT group(2.10+0.51 vs 1.62+0.52, P<0.05). The incidence of postoperative complications and infection was significantly lower and the number of days of postoperative hospitalization was significantly decreased in EN group than those in CONT group. Conclusions Preoperative enteral immunonutrition in patients with gastrontestinal cancer can improve the patients' nutritional status and immunity, and decrease the incidence of postoperative complications and infection.