营养支持对肝脏外科患者营养和免疫恢复促进作用的研究

NUTRITIONAL SUPPORT IMPROVED THE NUTRITIONAL STATUS AND IMMUNOFUNCTION OF THE PATIENTS WITH LIVER DISEASE

目的 观察营养支持对肝脏外科患者术后机体蛋白贮备和免疫功能的影响。方法 选择肝脏外科患者2 1例 ,术后予以营养支持。肠外营养非蛋白质热卡为 2 0～ 2 5kcal/(kg·d) ,供氮 0 .15～ 0 .2 0 g/(kg·d) ,糖脂供能比为2∶1,全部营养素配制成全营养混合液 (TNA) ,经中心静脉或外周静脉输注 ,每天输注 12～ 16小时 ,连续观察 1周。在术前、术后 1、4、7天测定血浆白蛋白、转铁蛋白 (TSF)、前白蛋白 (pre Alb)和免疫指标 (IgG、IgA、IgM、IgE ,CH 5 0、C3、C4、CD3、CD4 、CD8、NKC)以及氮平衡变化。结果 术后前白蛋白及转铁蛋白均有明显下降 ,于第 4天达最低值 ,术后 7天升高 ;氮平衡变化在术后 3天内出现明显的负氮平衡 ,第 4天转为正氮平衡 ;术后免疫指标均有不同程度的下降 ,以IgG、IgE ,CH5 0、CD3、CD4 及NKC为明显 ,但术后第 7天有所回复并接近术前值 ,且高于术后第 1天水平 (P <0 .0 5 )。结论 肝脏外科患者术后行肠外营养支持是安全有效的 。

HT6”,5”] [WT5”BZ] [WT5”HZ]Objective [WT5”BZ]To observe the effect of parenteral nutrition (PN) on the protein storage and immunofunction in patients with liver cirrhosis. [WT5”HZ]Methods [WT5”BZ]PN regimes consisted of nonprotein calories (NPC) 20-25 kcal/(kg·d) and nitrogen 0.15-0.20 g/(kg·d), the energy ratio of the glucose and fat emulsion was 2∶1. The PN solution was infused by total nutrition admixture (TNA), 12-16 hours per day for 7 days in 21 liver cirrhosis patients. Perior to the surgery and at 1st, 4th, 7th postoperative day, serum pre Alb, transferrin (TSF), immunofunction (IgG, IgA, IgM, IgE, CH50, C3, C4, CD 3, CD 4, CD 8, NKC), and nitrogen balance were tested. [WT5”HZ]Results [WT5”BZ]Serum pre Alb, TSF, nitrogen balance and IgG, IgE, CH50, CD 3, CD 4, NKC were significantly decreased ( P <0.05), but the foregoing indices were higher than those of postoperative 1, 4d as compared with postoperative 7d. [WT5”HZ]Conclusion [WT5”BZ]These results strongly indicated that postoperative nutritional support is safe and useful, and improve the patient’s nutritional status and immunofunction. [HT6,5”] [WT5”HZ]