术后早期肠内免疫营养对胃肠癌病人营养状态、免疫功能和炎症反应的影响

Effect of postoperative early enteral immunonutrition on nutritional status,immune function,stress status in gastrointestinal cancer patients

目的:评价早期肠内免疫营养(IEN)对胃肠癌根治术后病人营养状态、免疫功能、炎症反应和感染并发症的影响。方法:将72例胃肠癌病人随机分为IEN组、标准肠内营养(SEN)组和肠外营养(PN)组,另设空白对照组。IEN组病人于术后第1天起给予IEN液(瑞能),SEN组病人于术后第1天起给予SEN液(能全力),PN组病人于术后第1天起给予PN液。所有病人均于术前和术后第1、4、9天分别检测营养指标(ALB、PA、TF),免疫指标(TLC、CD4、CD8、CD3、IgA、IgG、IgM)和炎症指标(C3、C4、CRP),并观察记录术后肠道功能恢复时间及感染性并发症的发生情况。结果:三组病人术前的营养指标、免疫指标(除CD8外)均显著低于空白对照组(P﹤0.05),CD8和炎症指标显著高于空白对照组(P﹤0.05)。IEN组病人术后第9天免疫指标(除CD8外)显著高于SEN组和PN组(P﹤0.05、P﹤0.01);CD8和CRP水平显著低于SEN组和PN组(P﹤0.01);术后肠道功能恢复时间亦显著短于PN组(P﹤0.01)。结论:胃肠癌病人术后早期应用IEN液能维持营养状态,恢复免疫功能,降低全身炎症反应,促进肠道功能恢复。

Objective： To evaluate the clinical effect of postoperative early enteral immunonutrition on nutritional status, immune function, stress status and infectious complications in gastrointestinal cancer patients. Methods： Seventy-two patients with gastrointestinal cancer were randomly divided into 3 groups： IEN group （immune-enhancing enteral nutrition）, SEN group （standard enteral nutrition） , and PN group（ parenteral nutrition）. The levels of nutrition status （ ALB, PAB, TF）, immune function （TLC, CD4, CDS, CD3, IgA, IgG, IgM）, and stress status（C3, C4, CRP） were detected before operation and on postoprative day 1,4,9. The postoperative infection and bowel function were observed. Results： On the 9th day after operation, there was no statistic difference between each group on the serum levels of nutrition index（P 〉 0. 05）. The serum levels of CD3, CD4, IgA, IgM, IgG and the ratio of CD4/CD8 in IEN group were significantly higher than those in SEN group and PN group, while the serum levels of CD8 and CRP in IEN group were significantly lower than those in SEN group and PN groups. Conclusion： The application of postoperative early IEN can maintain normal nutrition status, enhance immune function, lower systemic inflammatory reaction and accelerate the restoration of bowel function in patients with gastrointestinal cancer.