不同配方肠内营养支持对胃癌病人术后营养的作用

Influence of different enteral nutritional support regimens on the nutritional status of post-operative patients with gastric cancer

目的:评定不同配方肠内营养支持对胃癌病人围手术期营养状况的作用。方法:随机将45例进展期胃癌根治术病人分成对照组、实验A组和实验B组,各组15例。对照组为普通输液组;实验A组肠内营养液不含谷氨酰胺;实验B组每升肠内营养液含谷氨酰胺13.0g。实验组术后第2天起给予肠内营养104.5 kJ/(kg.d),连续7 d,分别测定各项营养指标和免疫指标,检测血浆谷胱甘肽(GSH)和血清氨基酸浓度,观察临床转归。结果:除对照组出现2例肺部感染,其余均未发生严重并发症。实验组病人肱三头肌皮皱厚度(TSF)、上臂肌围(AC)和转铁蛋白(TRF)等营养指标下降明显减少,实验B组TSF和TRF更接近术前水平;术后第7天,实验B组病人血浆GSH浓度明显上升(P=0.035),与对照组(P=0.000)、实验A组(P=0.000)呈显著差异;实验B组CD4+和CD4+/CD8+明显高于对照组。实验B组患者血清丝氨酸(P=0.023)、精氨酸(P=0.031)、缬氨酸(P=0.018)、赖氨酸(P=0.034)和蛋氨酸(P=0.030)均有明显升高。结论:胃癌病人术后早期给予特殊肠内营养支持能有效提高GSH水平,增加CD4+细胞比例,显著增加体内必需氨基酸和半必需氨基酸浓度,改善机体营养和免疫状况。

Objective To study the effect of different enteral nutritional support regimens on the nutritional status of elderly post-operative patients with advanced gastric cancer. Methods Forty-five patients were randomly divided into 3 groups： control group（n=15）, experimental group A（n=15） and experimental group B（n=15）. The nutritional and immunological parameters, plasma glutathione hormone（GSH） level and the serum amino acid spectrum were determined before and 7 days after enteral nutritional support of 104.5 kJ/（kg·d）. Results Except 2 cases of lung infection in the control group, no serious complication occurred in the experimental groups. The losses of triceps skin fold （TSF）, ann circumference （AC） and transferrin （TRF） in the experimental groups were significantly decreased. TSF and TRF were closer to the pre-operative values of in group B. On the 7th day after operation, plasma GSH was moderately increased （P=0.035） in group B, and was significantly different from the control group （P=0.000） and group A（P=0.000）;CD4^＋ ceils and CD4^＋/CD8^＋ ratio were increased significantly in the group B, and the levels of serine （P=0.023）, arginine （P=0.031 ）, valine （P=0.018）, lysine （P=0.034）, and methionine （P=0.030） were increased significantly, too. Conclusions The early post-operative special enteral nutritional support can effectively raise the plasma GSH, significantly increase the CD4^＋ cells and the level of essential amino acids and ＂semi-essential＂ amino acids, resulting in improving the nutritional and immunological status of the organism.