胃肠癌患者术后早期肠外营养补充外源性清蛋白的研究

STUDY ON THE POSTOPERATIVE EARLY NUTRITION SUPPORT FOR PATIENTS WITH GASTROINTESTINAL CANCER BY ADDITIONAL ALBUMIN

[目的]研究胃肠癌患者术后早期肠外营养(PN)支持补充外源性清蛋白前后血液营养指标和体液免疫指标的变化,并探讨其临床意义。[方法]32例胃肠癌患者术后随机分为两组:营养组(n=17),对照组(n=15)。营养组于术后24h开始营养治疗,分析两组患者术前及术后1d、8d血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TRF)、免疫球蛋白(IgA、IgG、IgM)、预后营养指数(PNI)值的变化。[结果](1)血液营养指标:胃肠癌患者术后当天血清ALB、PA均显著低于术前,TRF、PNI有降低趋势;术后营养支持后8d时上述指标均恢复到术前水平,ALB、PA升高较为明显,而术后对照组8d时ALB、PA、TRF、PNI下降更为严重;术后8d时营养组与对照组比较所有被检血液营养指标均有统计学差异。(2)体液免疫指标:胃肠癌患者术后当天血清IgA、IgM均显著低于术前;术后营养支持后8d时IgA、IgM均恢复到术前水平,IgM升高较为明显;术后对照组8d时IgA、IgG、IgM降低更为严重。术后8d时对照组的IgG和IgM与营养组比较有统计学差异。[结论]低蛋白血症广泛存在于胃肠癌患者中,大手术可致血清蛋白水平进一步下降,术后早期肠外营养支持补充外源性清蛋白能改善患者术后营养状况及机体免疫功能,有助于促进术后患者康复。

[ Objective ] To study the changes and clinical significance of hemotrophic nutrition indexes and humoral immunity before and after the early postoperative parenteral nutrition suppory of patients with gastrointestinal cancer by additional albumin. [Methods] 32 cases were randomly divided into two groups, namely PN group （17 cases） and control group （15 cases）, the antritional therapy was started at the time of 24 hours after the operation. Albumin （ALB）, prealbumin （PA）, transferring （TRF）, total lymphocyte count （TLC） and intmunoglobulin （IgA, IgG, IgM） of 32 patients were detected and compared between the both groups pre-operation and post-operation. [ Results] （l） Hemotrophic nutrition indexes： When compared with pre-operation, the ALB and PA were significantly lower in patients with gastrointestinal, and a decreasing tendency of TRF and PNI was found after operation on the first day; With early postoperative parenteraI nutrition, all hemotrophic nutrition indexes of PN group recovered to the preoperative level and increased greatly, while these indexes of control group decreased mote greatly; All detected nutrition indexes were significantly lower in control group than those in PN group after operation on the eighth day. （2） humoral immunity indexes： Compared with pre-operation, the IgA and IgM were significantly lower in those patients after operation on the first day; After early postoperative parenteral nutrition, all detected humoral immunity indexes on PN group recovered to the preoperative level on the eighth day and the IgM increased greatly, while immunity indexes including IgA, IgG and IgM in control group had significantly decreased; there was significant difference on IgG and IgM between PN group and control group at the eighth day. [Conclusion] There could be a hypoproteinemia state on gastrointestinal cancer patients and blood protein level deceased greatly after operation, and the early postoperative parenteral nutrition support can improve nutritional state and immune function and contribute to patients＇ rehabilitation.