围手术期肠内免疫营养对老年胃癌患者免疫功能的影响

Effects of perioperative enteral immunonutrition in elder patients underwent radical operation for gastric cancer

目的观察围手术期肠内免疫营养(瑞能及谷氨酰胺)对老年胃癌患者免疫功能的影响。方法50例营养不良行胃癌根治手术老年患者随机分为研究组和对照组。两组采用等热量营养支持,术前7天和术后第2～8天分别接受免疫增强型肠内营养和标准肠内营养(能全力)。术前1天和术后第1、9天分别检测外周血淋巴细胞计数、IgG、IgA、IgM、T细胞亚群(CD4、CD8、CD4/CD8)和人类白细胞抗原-DR(HLA-DR)水平,并观察两组术后感染并发症和术后住院时间的差异。结果研究组术后第9天淋巴细胞计数、IgG、CD4、CD4/CD8及HLA-DR的表达较对照组显著回升(P<0.05),术后感染性并发症发生率略低于对照组(4%vs 20%)(P>0.05);研究组术后平均住院日少于对照组[(11.8±1.1)d vs.(12.7±1.2)d](P<0.05)。结论围手术期肠内免疫营养较标准肠内营养更有利于老年胃癌患者免疫功能的恢复。

Objective To evaluate the effects of perioperative enteral immunonutrition on immune function in elder patients with gastric cancer. Methods Fifty elder patients with malnutrition underwent radical operation for gastric cancer were randomized to receive either an enteral immune enhancing diet（study group） or an isocaloric control diet（control group） in 7 days before and on the 2^nd to 8^th day after surgery. The total lymphocyte count （TLC）, immunoglobin （IgG, IgM, IgA）, T lymphocyte subsets and human leukocyte antigen-DR（HLA-DR） were determined as host immunity on one day before operation and on the 1^st to 9^th postoperative day. The differences between the two groups in postoperative infectious complications and hospital stay were observed. Results TLC, IgG, CD4, CD4/CD8 ratio and HLA-DR expression on the 9^th postoperative day were significantly higher in study group than those in control group （P〈0.05）. The rate of postoperative infectious complications in study group was lower than that in control group（4% vs. 20%）（P〉0.05）. The hospital stay after surgery was shorter in study group than that in control group[（11.8±1.1） d vs. （12.7±1.2） d]（P〈 0.05）. Conclusion The perioperative enteral imrnunonutrition is better than an isocaloric control diet in the improvement of the host immune function in elder patients with malnutrition underwent radical operation for gastric cancer.