围手术期免疫增强型全肠外营养对胃肠恶性肿瘤患者术后免疫功能的影响

Effects of Immune-Enriched Total Parenteral Nutrition on Postoperative Immune Function in Patients with Gastrointestinal Cancer

目的:评价免疫增强型全肠外营养对胃肠恶性肿瘤患者术后免疫功能、营养状况及预后的影响。方法:120例消化道恶性肿瘤手术患者随机分为A组(术前和术后应用免疫增强型全肠外营养组)、B组(术后应用免疫增强型全肠外营养组)和对照组(常规全肠外营养组)。于入院时、术后第1天和第6天时分别检测各项免疫、营养及预后指标。结果:与入院时比较,3组免疫和营养指标于术后第1天降低,术后第6天均有所恢复。术后第6天,A、B组中的淋巴细胞总数和IgA、IgM、IgG、CD3、CD4、CD4/CD8值及中性数细胞吞噬率均显著高于C组,A、B组的术后感染性并发症发生率显著低于C组,平均住院时间则显著长于C组(P<0.05),而A组和B组间各项免疫及预后指标无显著差异(P>0.05)。研究期间各组白蛋白、前白蛋白和转铁蛋白血清浓度无显著差异(P>0.05)。结论:免疫增强型全肠外营养可增强胃肠恶性肿瘤患者术后机体免疫功能并改善预后。

Objective：To study the effect of Immune-enriched total parenteral nutrition（TPN） on the postoperative immune function,nutritional status and prognosis in the patients with gastrointestinal cancer.Methods：A hundred and twenty patients with gastrointestinal cancer were randomly divided into three groups.One group was given TPN supplemented with glutamine and arginine before and after operation（Group A）,One group was given TPN supplemented with glutamine and arginine only after operation（Group B）,and the other group was given conventional parenteral nutrition after operation as the control group（Group C）.The nutrition status,immune function and prognostic indicators were measured on admission day,on the first day and the sixth day after operation respectively.Results： Compared with the admission day,the levels of most humoral and cellular immune parametes declined on the first day,but they resumed on the sixth day after operation.Compared with the group C,TLC、IgA、IgM、IgG、 CD3、CD4、CD4/CD8 and the rate of neutrophil phagocytosis were higher in the group A and B on the sixth day after operation（P0.05）,The infectious complications and The average length of stay were lower in the group A and B on the sixth day after operation（P0.05）,however,there were no significant difference between group A and B.During the study,there were no significant difference for albumin、prealbumin and Tf between each group.Conclusions： TPN supplemented with glutamine and arginine can improve the immune function and prognosis in patients with gastrointestinal cancer.