老年人胃癌全胃切除术后早期肠内营养及对免疫功能影响的观察

Observation of postoperative early enteral nutrition and immunologic function in elderly gastric cancer patients after total gastrectomy

目的评价老年人胃癌全胃切除术后早期肠内营养（EEN）支持的安全性及对术后营养状况、免疫功能的影响。方法66例老年人胃癌全胃切除术后患者随机分为两组，EEN组和肠外营养（PN）组，每组各33例。EEN组术中放置空肠造口管，术后24h以内管喂肠内营养液肠内高营养多聚合剂（能全力），PN组给予等氮、等热量的标准PN，总热量为125kJ/（kg·d）。术前1d、术后第1、10天观察并比较两组营养免疫指标、胃肠功能恢复时间和营养支持费用。结果所有病例无手术死亡、无严重并发症发生；在术后第10天前白蛋白和转铁蛋白以及白细胞介素（IL）-2水平EEN组较PN组均明显升高（P〈0．05）。术后第1天两组患者IgM、IgA、IgG水平均下降，术后第10天EEN组IgA水平明显高于PN组（P〈0．05）。EEN组较PN组术后肠道功能恢复早、住院时间短。结论老年人胃癌全胃切除术后EEN安全、有效，且价格低廉；可促进术后免疫功能早期恢复，是值得推广的营养支持方式。

Objective To evaluate the safety of early enteral nutrition （EEN） and the effect of EEN on postoperative nutritional status and immunologic function in the elderly patients with gastric cancer after total gastrectomy. Methods Sixty-six cases of elderly gastric cancer patients,who underwent the same elective operation for total gastrectomy,were prospectively randomized into two groups （33 cases in each group）. The EEN group, which was received jejunostoma tube infusion with nutrison from the first postopera- tive day, and the parenteral nutrition（PN） group, which was received isocaloric and isonitrogenous nutritional formulas with EEN group on the same postoperative day with the nutritional goal 125 kJ/（kg· d ）, the nutrition state, time of gastroenteral function recovery and the expenditure were analyzed in both groups preoperatively,on the first and the tenth postoperative days. Results Neither mortality nor serious morbidity occurred in any of the patients during the period of study, the concentrations of serum prealbumin and transferrin were significantly elevated after nutrional support in EEN group. Interleukin-2 was also higher in EEN group on the tenth day after operation （P 〈 0.05 ）. Serum IgG, IgA and IgM levels decreased slightly on the ftrst day after operation. IgA levels were significantly higher in EEN group than those in PN group on the tenth day after operation. The intestinal function recovered earlier in EEN group and enjoyed shorter hospital stays to comparing with PN group, Conclusions EEN via jejunostoma tube infusion is safe, and cost effective after total gastrectomy in elderly patients. EEN may have beneficial effects on the early recovery of immunologic function in elderly patients with total gastrectomy. Elderly patients with total gastrectomy might benefit the most from EEN.