胃肠肿瘤病人术后早期肠内营养支持对机体细胞免疫的影响

The effect of postoperative early enteral nutrition on cellular immunity in patients with gastrointestinal cancer

目的研究术后早期肠内营养支持对胃肠肿瘤病人细胞免疫功能的影响。方法将20例病理证实为胃肠肿瘤的病人随机分为两组，PN组和EN组。PN组术后行PN支持，能量力105KJ·kg-1·d-1，氮入量0．2g·kg-1·d－1。EN组术后第一天起经鼻饲管输注能全力，量由500ml/d递增至1500ml／d，速度由20ml／h递增至60ml／h。分别于术前及术后第8天抽取外周血测定T细胞亚群、NK细胞、血清IL-2浓度。结果术后经一段时期的EN和PN支持后T细胞亚群恢复到术前水平，NK细胞明显增高（P＜0．05）。EN组IL-2明显增高（P＜0．05），与PN组术后IL-2比亦有显著差异（P＜0．05）。结论术后早期应用肠内营养支持较肠外营养支持更有利于改善胃肠肿瘤病人的细胞免疫功能。

Objective To elucidate the effect of postoperative early enteral nutrition support(ENS) on cellular immunity function of gastrontestinal (GI) cancer patients. Methods Twenty patients with Gl cancer diagnosed pathologically were divided into two groups: enteral nutrition group (EN-group, 10 cases), parenteral nutrition group (PN-group, 10 cases). PN-group was given total parenteral nutrition (TPN), 105kJ/(kg.d) of energy, N 0. 20g/(kg. d). In ENgroup, the naso-intestinal tube was placed 30cm posterior to ligamen Treitz or jejunal export loop. Since the 1st postopera-tive day Nutrison was infused, infused volume was increasingly added from 500ml/d to 1500ml/d, infused rate was stepby-step increased from 20ml/h to 60ml/h. T-cell subgroup, NK cell, IL-2 were measured in the day before operation and on the 8th postoperative day. Results T-cell subgroup returned to preoperative level,NK cell were obviously increased (P<0. 05) in two groups, interlukin-2 (EN-group) were greatcy increased(P < 0. 05) and were significant differences from PN-group (P<0.05). Conclusions ENS helps to ameliorate the cellular immunity function of postoperative GI cancer patients better than PNS.