不同氮量低热量肠外营养对食管癌术后患者临床结局的影响

Influence of Hypocaloric and Different Nitrogen Concentration Parenteral Nutrition(PN) on Clinical Outcome of Postoperative Esophageal Cancer Patients

目的:评价不同氮量低热量肠外营养对食管癌术后患者临床结局的影响。方法:回顾性分析68例食管癌患者,分为低氮组和中氮组。低氮组(n=36)按非蛋白热量18Kcal(16～20)kg/d、氮0.10g(0.09～0.11)kg/d使用两组规格的即用型三腔袋(卡文,Kabiven)配制。中氮组(n=32)亦采用卡文三腔袋,另外补充7%乐凡命维持氮在0.20g(0.18～0.22)kg/d。术后连续6d经外周或经外周中心静脉提供肠外营养支持。比较两组患者血浆总蛋白、白蛋白、前白蛋白和转铁蛋白浓度和免疫学指标IgA、IgG、IgM、CD3、CD4/CD8以及氮平衡、术后并发症的变化。结果:术后7d,低氮组和中氮组血浆总蛋白、白蛋白、前白蛋白和转铁蛋白浓度较术前有所降低,但两组比较差异均无显著性,P>0.05;C-反应蛋白两组患者比较亦无统计学差异,P>0.05。两组患者术后均呈负氮平衡,于术后第6天即恢复正氮平衡,两组比较差异亦无显著性,P>0.05。两组患者无一例出现切口感染或愈合不良、吻合口瘘及尿路感染,各组均出现1例术后肺部感染,无一例围手术期死亡。结论:本研究提示低氮低热量配方的卡文三腔袋用于食管癌术后营养支持安全,有效,无需另外补充氨基酸。需开展前瞻性随机对照研究进一步证实。

Objective Evaluate the influence of hypocaloric and different nitrogen concentration parenteral nutrition on the clinical outcome of postoperative esophageal cancer patients.Methods Retrospective analysis of 68 patients with esophageal cancer, who underwent radical surgery in our department.They were divided into low nitrogen concentration group （n=36）and medium nitrogen concentration group （n=32）.Low nitrogen concentration group consist of 18 Kcal （16- 20） kg/d and nitrogen 0.10 g （0.09 -0.11）kg/d in Kabiven instant use three-chambers bag.Medium nitrogen concentration group consist of 18 Kcal（16-20）kg/d and nitrogen 0.20 g（0.18-0.22）kg/d with extra support of amino acids （novamin）.PN was infused continuously for six postoperative days through peripherally inserted central catheter. The levels of total protein,albumin, pre-albumin,transferrin,IgA,IgG,IgM,CD3 ,CD4/CD8,nitrogen balance and complications were compared between the two groups.Results On POD 7,the levels of total protein,albumin, pre-albumin,transferrin and CRP were not significantly different between the two groups,P〉0.05 ;on POD 6, the negative nitrogen balance was reversed in the two groups, but also there was no significant difference between the two groups,P〉0.05.No wound infection,anastamosis fistula and urinary infection occurred in both groups. 1 case of patient with postoperative pulmonary infection was recorded in each group and there was no perioperative death.Conclusion Hypocaloric and low nitrogen PN in three-chambers bag is safe and effective for nutritional support of postoperative esophageal cancer patients.Prospective and randomized control study is needed.