胰十二指肠切除围手术期肠内免疫营养对机体免疫功能调节的影响与护理

Clinical study and nursing observation of effect of perioperative enteral immunonutrition on the host immune function in pancreatoduodenectomy patients

目的研究胰十二指肠切除围手术期肠内免疫营养对机体免疫功能调节的效果和肠内营养护理重点。方法本研究是一个前瞻、随机、单盲、对照的临床研究。将40例符合研究标准的胰十二指肠切除患者随机分为肠内免疫营养治疗组（EIN组，20例）和普通肠内营养治疗组（EN组，20例）；于营养治疗前、术前1d、术后第1、7、14、21、28天测定血中T淋巴细胞亚群、NK细胞、免疫球蛋白等的变化情况及观察肠内营养时胃肠道及造瘘管的并发症。结果术前1dCD3、CD4、NK细胞显著上升，CD8显著下降，且术前1dEIN组CD3、CD4显著高于EN组（P〈0．05）；术后第1天细胞免疫功能呈明显下降状态，且持续到术后第7天；自术后第14天开始，机体细胞免疫功能开始恢复。体液免疫功能恢复无明显时间差异，但术后第1、7、14、21、28天EIN组IgA明显高于EN组（P〈0．05）。40例患者空肠造瘘管应用良好，无导管阻塞，造瘘处皮肤无红肿和炎性渗出及其他造瘘管相关并发症，本组无明显腹痛、腹胀、腹泻等肠内营养相关并发症发生。结论肠内免疫营养治疗能够有效上调细胞和体液免疫，从而改善机体的免疫功能，其疗效优于普通肠内营养；心理护理、完善的营养计划、造瘘管的护理及观察营养时可能出现的并发症等良好细致的护理是成功实施肠内免疫营养的保证。

Objective To evaluate the effect of perioperative enteral immunonutrition on the host immune function in pancreatoduodencctomy patients, and nursing experience for enteral nutrition. Methods Forty pancreatoduodenectomy cases were divided into enteral immunonutrition （EIN） group and regular enteral nutrition （EN） group with 20 cases respectively. The complications related to enteral nutrition were carefully observed. Host immunity function were measured by CD3, CD4, CD8, CD4/CD8, NK, IgG, IgM, IgA on pre-nutrition, pre-operative 1 day, postoperative 1, 7, 14, 21 and 28 day. Results Forty cases all completed the study and smoothly recovered from operation. Compared with pre-nutrition, CD3, CD4 and NK were significantly increased and CD8 was significantly decreased in pre-operative 1 day. Synchronously, CD4/CD8 was significantly increased in EIN group, and its CD3 and CD4 was higher than EN group. Although cellular immune function was inhibited in postoperative 1 day, CD3 and NK of EIN group was higher than EN group. Cellular immune function began to recover from postoperative 14 day. Furthermore EIN and EN group obtained notable recovery on cellular immune function in postoperative 21 and 28 day respectively. Compared with pre-nutrition, all patients had higher level of IgA in pre-operative 1 day. At the time of postoperative 1, 7, 14, 21 and 28 day, IgA was higher in EIN group than EN group. 40 patients showed no complications such as flare and fistula inflammatory effusion and no enteral nutrition related complications in terms of obvious abdominal pain, diarrhea, abdominal distension. Conclusions Compared with regular enteral nutrition, enteral immunonutrition has advantages in relieving serious immune suppression, up-regulating cell immunity and humoral immunity. Fine nursing cares such as psychological nursing, perfect plan and finding the early complications of nutrition are the essentials for successful enteral nutrition application.