全胃切除术后早期免疫增强型肠内营养支持的应用

Study of postoperative immune enhanced enteral nutrition in patients with total gastrectomy

目的研究胃癌患者行全胃切除术后早期应用免疫增强型肠内营养对机体恢复、免疫功能及炎性反应的影响。方法选择进展期胃癌患者，行全胃切除、食管空肠Roux—en-Y吻合及行食管空肠袢式吻合（少数几例）病例56例，随机分成2组：免疫增强型肠内营养组（实验组）和常规肠外营养支持组。二组患者均从术后第1天起从营养管道进行肠内和肠外营养，肠内营养组（实验组）使用免疫增强型肠内营养制剂，肠外营养组使用力能脂肪乳剂和复方氨基酸制剂。共1～7d，于术后第1、8天及术前分别抽取外周血测定血清总蛋白、白蛋白、前白蛋白、IgG、IgA、IgM，T淋巴细胞亚群、IL-2。结果两组血清总蛋白、白蛋白、前白蛋白及氮平衡均无显著差异。术后第8天实验组IgG、IgA、IgM、CD3、CIM和CIM／CD8均显著高于PN组（P〈0．05）。结论胃癌根治性全胃切除术患者术后早期免疫增强型肠内营养支持可有效改善患者免疫功能，并能减轻机体的炎症反应。

Objective To study the effect of early immunoenhancement enteral nutrition support in organism recover, immune function and inflammatory reaction in patients with gastric cancer after total gastrectomy. Methods 56 advanced gastric cancer patients who reveived total gastrectomy, esophag - jejunum Roux - en - Y inosculation and esophago - jejunum inosculation were divided into 2 groups ： immunoenhancement enteral nutrition group and parenteral alimentation group. Two groups received enteral nutrition and parenteral alimentation from the first day to the seventh day after operation , in which enteral nutrition group use immunoenhancement enteral nutrition and parenteral alimentation group use intralipid and amino acid. Preoperative and the lth, 8th day postoperative total serum protein, albumen, prealbumin, IgG, IgA, IgM, T lympholeukocyte subgroup and IL -2 in peripheral blood were detected. Results Total serum protein, albumen , prealbumin and nitrogen balance of two groups have no significance. IgG,IgA,IgM,CD3,CIM and CDd/CD8 of immunoenhancement enteral nutrition group were significant higher than parenteral alimentation group （P 〈 0. 05 ）. Conclusions Early immunoenhancement enteral nutrition support in patients with gastric cancer after total gastrectomy can improve immune function and relieve inflammatory reaction of organism.