肠内营养在全胃切除术后返流性食管炎治疗中的应用

Effects of Enteral Nutrition on Treatment of Grave Reflux Esophagitis Patients after Total Gastrectomy

目的研究肠内营养在重症返流性食管炎治疗中的作用及其对患者免疫功能的影响。方法将62例胃癌病人随机分为肠外营养组(PN组)和肠内营养组(EN组),每组31例。治疗上给予等氮、等热量的营养支持。观察两组患者在治疗过程中的不良反应,检测治疗前和治疗后第8天病人的体质量、肱三头肌皮皱厚度(TSH)和上臂肌围(AMC)、血清ALB等营养指标及从治疗开始到能经口进食的时间(进食间隔时间),并同时检测淋巴细胞亚群(CD4、CD8、CD4/CD8)等细胞免疫指标。结果两组患者在治疗过程中均有不良反应的发生,但均可以完成治疗。治疗后第8天各项营养指标无明显变化,组间无统计学意义(P>0.05)。但EN组病人的进食间隔时间明显短于PN组,组间有统计学意义(P<0.05)。治疗后与治疗前相比及两组之间治疗后相比均表现为CD4、CD4/CD8明显提高,EN组明显好于PN组,差异有统计学意义。CD8也有所提高但差异无统计学意义。结论肠内营养在治疗胃癌术后重症返流性食管炎方面是安全、可行、有效的。肠内营养支持对改善病人细胞免疫功能方面优于肠外营养。

Objective To evaluate the effects of enteral nutrition on the treatment and immune function of grave reflux esophagitis patients.Methods Sixty-two patients were randomly divided into enteral nutrition （EN, n= 31） groups, and parenteral nutrition （PN, n=31） groups. Two study groups were treated with isocaloric and isonitrogonous nutrition to observe incidence rate of untoward reaction in treatment.Nutritional variables such as bodyweight, TSH, AMC,serum albumin,time from pretherapy to eating, subsets of lymphocytes （CD4, CD8, CD4/CD8） were measured on pretherapy and the 8th day after pretherapy.Results Untoward reaction occurs in two study groups , but the treatment could be finished. Nutritional variables were indifferent between pretherapy and the 8th day after pretherapy（P0.05）. Nutritional variables were no change between EN group and PN group（P0.05）. Time from pretherapy to eating in EN group were significantly lower than that in PN group （P0.05）. The percentage of CD4 and the number of CD4/CD8 in EN group were significantly higher than that in PN group （P0.05）. The percentage of CD4 and the number of CD4/CD8 in the 8th day after treatment were higher than that in pretherapy （P0.05）. CD8 were raised on two study groups, but there were no statistical differences between EN group and PN group.Conclusion EN as the treatment was safe,feasible and effective. EN compared with PN could effectively improve cell immunity of patient.