消化道肿瘤术后早期营养对免疫和应激反应的作用

Effects of Early Postoperative Nutritional Support on Immune System and Inflammatory Responses after Gastrointestinal Surgery

目的比较消化道恶性肿瘤术后早期肠内营养(EEN)+肠外营养(PN)与术后早期完全胃肠外营养(TPN)对患者应激和免疫指标的影响。方法将择期进行消化道恶性肿瘤根治手术患者随机分为EEN+PN组(22例)和TPN组(24例),两组患者分别于术后24小时开始等热量、等氮营养治疗。比较两组患者术前与术后1周CD3、CD4、CD8、CD4/CD8、IgA、IgG、IgM、C-反应蛋白(CRP)、肿瘤坏死因子α(TNFα)、白介素2(IL2)水平的差异。结果EEN+PN组术后7天CD3、CD4、IgM显著高于TPN组(P<0·05);TPN组术后1天IL2显著高于EEN+PN组(P<0·05)。两组患者术前、术后7天CD8、CD4/CD8、IgA、IgG、CRP、TNFα差异均无显著性(P>0·05)。结论EEN+PN在改善应激和免疫指标方面优于TPN,可成为消化道肿瘤患者术后首选的营养方式。

Objective To evaluate the effects of early postoperative enteral nutrition （EEN） and total parenteral nutrition （TPN） on immune system and inflammatory responses of gastrointestinal neoplasm patients undergoing major abdominal surgery. Methods Forty-six patients undergoing gastrointestinal neoplasm radical surgery from October 2001 to March 2003 were studied prospectively. They were randomly divided into two groups： EEN ＋ PN group （22 patients） and TPN group （24 patients）. The nutritional support was started within the first 24 hours postoperatively with isocaloric and isonitrogenous regime. Immune and inflammatory responses parameters were measured before operation and at the postoperative intervals. Results T-lymphocyte subsets maintained stable in EEN ＋ PN group, and decreased in TPN group. CD3, CD4, and IgM in EEN ＋ PN group were significantly higher than those in TPN group on the 7th day after operation （ P 〈 0.05 ）. The level of interleukin2 （ IL2 ） in TPN group was significantly higher than that in EEN ＋ PN group on the 1^st day after operation （ P 〈 0. 05 ）. No significant differences were found between the two groups in C-reactive protein, tumor necrosis factor-α, CD8, CD4/CD8, IgA, and IgG before operation and on the 1^st, 3^rd and 7^th day postoperatively （P 〉 0. 05）. Conclusion EEN ＋ PN improves immune responses and may be the first choice for nutritional support in patients undergoing gastrointestinal surgery.