早期营养支持对食管癌患者术后免疫功能的影响

Effects of early postoperative nutritional support on immune function in patients underwent resection of esophagus cancer

目的探讨不同途径营养支持对食管癌患者术后免疫功能、营养状况的影响。方法83例食管癌术后患者分为肠内营养组(EN组,40例)和肠外营养组(PN组,43例)。两组均于术后第1天开始营养支持。于术前、术后第3、7天取外周血检测白蛋白、前白蛋白、免疫球蛋白浓度(IgA、IgG、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)、超敏C反应蛋白(CRP)和前列腺素E2(PGE2)。记录术后并发症和住院天数。结果 EN组术后胃液引流量较PN组少[(750.56±73.62)ml vs.(1250.85±103.77)ml](P<0.05),首次排气时间较PN组早[(53.21±5.24)h vs.(69.12±8.68)h](P<0.05),住院时间较PN组缩短[(12.4±1.6)d vs.(16.7±2.3)d](P<0.05)。EN组营养状况改善优于PN组;两组术后免疫功能均有抑制,但EN组患者在术后第3、7天免疫功能指标较PN组高(P<0.05)。两组的炎性指标在术后第3天增高,EN组术后第7天下降更为明显(P<0.05)。结论食管癌患者术后早期采用EN营养支持能更有效改善患者的营养状况和免疫功能,减轻机体的炎症反应,促进患者的恢复。

Objective To investigate the effects of early postoperative nutritional support on immune function in the patients underwent resection of esophagus cancer. Methods Eighty-three patients with esophagus cancer were randomized into two groups of EN （40 cases, re6eived early postoperative entenal nutritional support） and PN（43 cases, parenteral support）. The patients received nutritional support on the 1st day after operation. The peripheral blood samples were taken for the measurement of the albumin and prealbumin, immunoglobulines of IgA, IgG and IgM, T-lymphocyte subgroups of CD3^＋ , CD4^＋ and CD4^＋/CD8^＋ , hypersensitive C-reactive protein（CRP） and parastata voxel（PGE） before operation and on the 3rd and 7th day after operation. The postoperative complications and hospital stay were recorded. Results Compared to group PN, in group EN, the drainage amount of gastric fluid was less[（1250.85 ± 103.77） ml vs. （750.56 ±73.62） ml] （P〈0. 05）,the time of aerofluxus was earlier[（69.12± 8.68） h vs. （53. 21± 5.24） hi （P〈0. 05）, hospital stay was shorter[（16.7±2.3） d vs. （12.4±1.6） d]（P〈0. 05）, and the improvement in the nutritional status was more. The immune function was reduced in both groups, but the parameters of immune function on the 3rd and 7th day after operation were higher in group EN than those in group PN（P〈0. 05）. The inflamatory parameters on the 3rd day after operation were increased in both groups,which on the 7th day after surgery were lower in group EN than those in group PN （P〈0. 05）. Conclusion In the patients underwent surgery for esophagus cancer, early postoperative nutritional support with EN is better than that with PN in improving nutritional status and immune function, reducing inflammatory response,and promoting rehabilitation.