消化道恶性肿瘤术后早期肠内营养对免疫功能的影响

Effect of early enteral nutrition on immunologic function after operation for alimentary tract malignant tumor surgical patients

目的探讨消化道肿瘤病人术后早期肠内营养对机体免疫功能的影响。方法51例消化道恶性肿瘤病人随机分为早期肠内营养组(enteral nutrition EN组)与肠外营养(parenteral nutrition PN组),EN组27例,PN组24例。EN组术后24h开始经鼻胃管予以肠内营养液能全力,PN组给予等氮、等热卡的肠外营养,营养支持共7d。两组病人分别术前和术后第1d、第8d检测免疫指标C3、C4、IgA、IgM、IgG和CD3+、CD4+、CD8+及CD4+/CD8+,并观察有无严重并发症,肠蠕动恢复时间和感染率变化。结果术后第1天两组病人IgG、IgM、IgA、C3、CD3+、CD4+、CD4+/CD8+比值均较术前有所下降,而术后第8天早期EN组IgG、IgM、IgA、C3、CD3+、CD4+、CD8+、CD4+/CD8+等免疫指标迅速恢复,与PN组比较差异显著(P<0.05)。两组病人在观察期间均无严重并发症,早期EN组病人胃肠功能恢复时间较PN组明显缩短(P<0.01),早期EN组感染率(12%)较PN组低。结论消化道恶性肿瘤术后早期肠内营养支持可以恢复和改善病人的免疫功能,并有利于胃肠功能的恢复,降低病人术后感染率。

Objective To study the effects of early enteral nutrition on immunologic function for alimentary tract malignant tumor surgical patients after operation. Methods 51 cases with alimentary tract malignant tumor were randomly divided into two groups, enteral nutrition group （27 cases） and parenteral nutrition group （24 cases）. TFP was started within the first 24 hours postoperatively by continuous pump infusion via a nasogastric tube in EN group and the isocaloric and isonitrogenous paxenteral nutrition was given in PN group. The nutritional support were 7 days. C3, C4, IgA, IgM, IgG and CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ of two groups were detected on the day before operation and the postoperative day 1^st and 8^th. Severely complications, the restoring time of intestinal peristalsis and infective rate were observed. Results The IgG, IgM, IgA, C3, CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ in the postoperative day 1^st were decreased compared with that before operation in the two groups. Recovery of immunologic function was more quicker in EN group than that in PN group in the postoperative day 8^th. The changes in EN group were significantly different from PN group （P〈0.05）. The two groups were no severely complications. The EN group was shorter than the PN group in the restoring time of postoperative intestinal peristalsis （P〈0.01）. The infective rate were higher in PN group than that in EN group. Condusions Early enteral nutrition may have beneficial effect on improving immunologic function, promoting the recovery of intestinal peristalsis and reducing postoperative infective rate.