肠内营养治疗全胃切除术后反流性食管炎的疗效及其对免疫功能的影响

Effect of enteral nutrition on treatment of postoperative reflux esophagitis in patients with total gastrectomy and its influence on immune function

目的分析肠内营养(EN)治疗全胃切除术后反流性食管炎患者的临床疗效及其对免疫功能的影响。方法将56例全胃切除术后反流性食管炎患者随机分为观察组28例和对照组28例。2组均给予等热量、等氮的营养支持,在此基础上,观察组在胃镜引导下进行EN,对照组经颈内中心静脉置管进行肠外营养(PN)。观察2组营养治疗过程中的进食间隔时间及不良反应发生情况,并比较治疗前及治疗后第8天的上臂肌围(AMC)、体质量、肱三头肌皮皱厚度(TCT)和血清白蛋白(ALB)等营养指标,以及CD4+、CD8+、CD4+/CD8+等免疫指标水平。结果治疗前及治疗后第8天,2组AMC、体质量、TCT及ALB等指标比较,差异均无统计学意义。营养治疗过程中,观察组进食间隔时间显著短于对照组,而2组不良反应发生率比较差异无统计学意义。治疗后第8天,2组CD4+和CD4+/CD8+水平均较治疗前明显升高;观察组治疗后第8天CD4+和CD4+/CD8+水平显著高于对照组,差异有统计学意义。结论应用EN能有效缩短全胃切除术后RE患者的进食间隔时间,纠正细胞免疫状态,安全、可行,且疗效优于PN。

Objective To analyze the clinical effect of enteral nutrition （EN） on the treat ment of postoperative reflux esophagitis （RE） in patients with total gastrectomy and its influences on immune function. Methods 56 patients with RE after total gastrectomy were randomly divided into observation group （n = 28） and control group （n = 28）, and both groups were conducted with nutritional support with the same amount of calories and nitrogen. On this basis, the observation group was given EN by gastroscope, while the control group was given parenteral nutrition （PN） by internal, carotid central venous indwelling catheter. In the process of nutritional treatment, intervals of food intake and adverse reactions were observed in both groups, and the levels of arm muscle cir cumference （AMC）, body weight, triceps brachii muscle crease thickness （TCT）, serum albumin （ALB）, CD4＋, CDs＋ and CD4＋/CD8＋ were compared before treatment and 8 days after treat ment. Results There were no significant differences of AMC, body weight, TCT and ALB before treatment and 8 days after treatment in two groups. In the process of nutritional treatment, the in terval of food intake in the observation group was significantly shorter than that in the control group, whereas there was no significant difference of adverse reactions between two groups. 8 days after treatment, levels of CD4 ~ and CD4 ＋/CD8 ＋ in both groups increased significantly, and the lev els of these indexes at the time point of 8 days after treatment in the observation group were signifi cantly higher than those in the control group. Conclusion Application of EN can effectively shorten the interval of food intake in patients with RE after total gastrectomy and retrieve cell imITiune fUD_C -tion. EN therapy is safe and feasible, and its etticacy is much better than PN therapy.