免疫型肠内营养在食管癌患者术后的应用比较

Clinical research on enteral immunonutrition in postoperative patients with esophageal cancer

目的评价食管癌术后患者早期肠内营养对患者营养状态、免疫功能、炎症反应和感染并发症的影响。方法将120例食管癌患者随机分为IEN组（免疫肠内营养组）和SEN组（标准肠内营养组）。所有患者均于术前和术后第1、4、9天分别检测营养指标（ALB、PA、TF）、免疫指标（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。结果两组患者的胃肠道功能恢复时间比较差异无统计学意义，IEN组感染并发症少于SEN组。术后第9天，两组患者的营养指标比较差异无统计学意义（P〉O．05）：IEN组的IgA、IgM和IgG水平显著高于SEN组，而IEN组C4、CRP水平显著低于SEN组（P〈0．05）。结论食管癌患者术后早期应用IEN能维持营养状态、恢复免疫功能、降低全身炎症反应，可能减少术后感染的发生。

Objective To evaluate the clinical effect of postoperative early enteral nutrition on nutrient status, immune function, stress status and infectious complications in patients with esophageal cancer. Methods Total 120 patients with esophageal cancer were randomly divided into two groups： IEN group（immune-enhancing enteral nutrition）and SEN group （standard enteral nutrition）. The levels of nutrition status （HGB, ALB, TF）, immune function （IgA, IgG, IgM） and stress status （C3, C4, CRP） were detected before operation and on postoprative 1, 4, 9 days. The postoperative infection and bowel function were observed. Results There was no statistic difference between the two groups on bow- el function, but the postoperative infection in IEN group was less than in SEN group. 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 tgA, IgM and IgG in IEN group were significantly higher than those in SEN group, while the serum levels of C4 and CRP in IEN group were significantly lower than those in SEN group （P 〈 0. 05 ）. Conclusions The application of postoperative early IEN with esophageal cancer can maintain normal nutrition status, enhance immune function, lower systemic inflammatory reaction in patients.