早期肠内营养对食管癌患者术后免疫功能和临床结局的影响

Effect of early enteral nutrition on immune response and clinical outcomes after esophageal cancer surgery

目的探讨早期肠内营养（EEN）对食管癌术后患者机体免疫功能和临床结局的影响。方法选取2011年3月至2012年7月在哈尔滨医科大学附属第四医院胸外科行根治性手术治疗的食管癌患者，采用信封法随机分为术后早期肠内营养组（EEN组，30例）和术后按传统治疗方案给予全肠外营养组（TPN组，30例），两组均行营养支持7d。两组患者分别于术前1d和术后第1、3、7天检测免疫学指标：CD3＋、CD4＋、CD8＋、CD4＋CD8＋比值；营养指标：血清白蛋白（ALB）和前清蛋白（PA）水平。并记录术后首次排气时间、术后住院时间、住院总费用及术后并发症。结果EEN组和TPN组患者术后首次排气时间[（66．5±7．3）h比（75．1±6．8）h，P=0．000]，住院时间[（7．8±1．1）d比（9．3±1．3）d，P=0．000]和住院总费用[（3．62±0．38）万元比（3．97±0．40）万元，P=0．001]比较，差异均有统计学意义。两组术后并发症发生率的差异无统计学意义[13．3％（4／30）比20．0％（6／30），P=-0．488]。术后第3和第7天EEN组患者CD3’、CD4’、CD4＋／CD8＋、ALB和PA均明显高于TPN组（均P〈0．05）：而CD8＋水平显著下降，与TPN组相比，差异亦有统计学意义（尸〈0．05）。结论早期肠内营养用于食管癌术后患者可促进胃肠道功能早期恢复，改善患者的营养状态，降低对免疫功能影响，加速患者的康复。

Objective To evaluate the effect of early enteral nutrition （EEN） on immune response and clinical outcomes after esophageal cancer operation. Methods Sixty patients with esophageal cancer undergoing radical operation between March 2010 and July 2011 were randomly divided into two groups using envelope method： EEN group （n=30, administration of water and enteral nutrition early after operation） and TPN group （n=30, administration of total parenteral nutrition）. Two groups both received 7-day nutrition support. Immune indexes （CD3~, CD4＊, CD8~, CD4＋/CD8~） and serum nutritional indexes （albumin, pre-albumin, transferrin） were measured before operation and 1-, 3-, and 7-day after operation. The time to first flatus, length of postoperative hospital stay, total hospitalization cost, and postoperative complication were recorded. Results As compared to TPN group, the time to first flatus was significantly shorter in EEN group [ （66.5±7.3） h vs. （75.1±6.8） h, P〈O.01 ], as was hospital stay[ （7.8±1.1） d vs. （9.3±1.3） d, P〈0.01 ]. Total hospitalization cost[ （36 210± 3810） yuan vs. （39 731-＋4013） yuan, P〈O.01] was lower in EEN group as compared to TPN group. There was no significant difference in postoperative complication rate between the two groups[13.3% （3/30） vs. 20.0%（6/30）,P〉0.05]. The levels of CD3＋, CD4＋, CD4＋/CD8＋, albumin, prealbumin and transferrin were significantly higher in EEN group as compared to TPN group on postoperative day 3 and 7 （all P〈0.05）, while CD8＋ was significantly lower in EEN group （P〈0.05）. Conclusion EEN canpromote early recovery of gastrointestinal function, improve nutritional and immune function, and therefore lead to fast postoperative recovery in esophageal cancer patients.