食管穿孔营养支持方式的探讨

Nutritional support of esophageal perforation

目的探讨不同营养支持方式对食管穿孔患者免疫功能的影响和临床治疗效果评价并归纳出合理的营养支持方式。方法将2001年3月至2005年6月我科收治38例食管穿孔患者按收治时间随机分为两组,对照组18例接受全肠外营养(TPN),实验组20例接受肠外加肠内营养(PN+EN),两组根据患者需要提供氮和热量。于治疗前后检测血浆总蛋白、白蛋白、血红蛋白和转铁蛋白浓度,外周血IgAI、gG、IgM、淋巴细胞总数(TLC)及T细胞亚群CD3、CD4百分率和CD4/CD8比值。并比较两组治愈率、平均住院时间和并发症。结果实验组TLC和IgG营养支持前后及与对照组相比其差异均有统计学意义(P<0.05);CD4和CD4/CD8比值也有升高,其差异有统计学意义(P<0.05);其余指标差异无统计学意义(P>0.05)。实验组较对照组治愈率稍高,平均住院时间稍短,但无统计学意义。结论PN+EN较TPN更能改善食管穿孔患者机体的免疫功能,促进患者更早康复,是食管穿孔比较合理的营养支持方式。

Objective To explore the effects of different nutritional support patterns on improvement of immunological function in the patients with esophageal perforation, and to summarize the reasonable nutritional support pattern. Methods ＂ Thirty- eight patients from March 2001 to June 2005 were divided into two groups in random. The patients in control group （ 18 cases） were treated with standard total parenteral nutrition （TPN）, and those in experimental group （20 cases） with parenteral nutrition （PN） combined with enteral nutrition （EN）. Two groups were supplied with nitrogen and caloricity according to the need of patients. Plasma levels of total protein, albumin, hemoglobin, peripheral plasma IgA, IgG and IgM concentrations and total lymphocyte counts （TLC）, the percentage of T lymphocyte subsets （ CD3, CD4 ）, the ration of CD4 and CD8 were detected before and after treatment. And the cure rate, average hospital stay and complications were compared. Results There was significant difference in TLC and IgG before and after nutritional support and between experimental group and control group （ P （0.05）. The percentage of CD4 and the ratio of CD4/CD8 were also increased evidently in experimental group as compared with those in control group （ P 〈 0.05 ）. There was no significant changes in the remaining items between experimental and control groups（ P 〉0.05）. The cure rate was slightly higher and hospital stay mildly shorter in experimental group than in control group with the difference being not significant（ P 〉 0.05）. Conclusion The nutritional support of PN ＋ EN can improve the immunological function of esophageal perforation patients and is a reasonable nutritional support pattern for esophageal perforation patients.