营养支持对体外循环术后患者细胞免疫功能的影响

The effect of nutrition support on cellular immunity in patients of cardiopulmonary bypass

目的 探讨营养支持对体外循环术后患者细胞免疫功能的影响。方法 将 30例体外循环术后患者随机分为 2组 :对照组和营养支持组 ,每组 15例。对照组自由进食 ,营养支持组在自由进食基础上 ,每日额外补充口服营养液 75 0ml,时间为 1周。分别于术前、术后第 1、 4、 8天等时间点抽外周血测定T淋巴细胞亚群(CD+3 、CD+4 、CD+8)及自然杀伤细胞 (NK)活性。结果 术后第 1天 ,两组病人T淋巴细胞功能受抑制 ,换双瓣者更明显 ,NK细胞活性变化不大 ;术后第 4天 ,营养支持组换双瓣者CD+4 和CD+8的反向变化得以纠正 ,与对照组比较差异显著 (P <0 0 5 ) ,NK细胞活性换双瓣者较术前明显降低 (P <0 0 5 ) ;术后第 8天 ,T淋巴细胞亚群功能基本恢复 ,NK细胞活性对照组换双瓣者仍未恢复术前水平 (P <0 0 5 )。结论 营养支持能改善体外循环术后患者的细胞免疫功能 。

Objective To investigate the effect of nutrition support on cellular immunity in patients of cardiopulmonary bypass(CPB).Methods Thirty patients having valve replacement for rheumatic heart valvular disease were randomly divided into two groups:control group and nutrition support group,15 cases in each group.Control group ate freely,nutrition support group took orally 750ml nutritional fluid every day on the basic of eating freely,last for one week.T Lymphocyte subsets (CD + 3?CD + 4?CD + 8) and natural killer cell activity (NK) were measured on preoperation day and 1,4,8 days after CPB.Results On 1st day after CPB,T-lymphocyte function was depressed in two groups,double valve replacement more significant,NK cell activity had no obviously change.On 4th days,CD + 4 was increased and CD + 8 was decreased in nutrition support group with double valve replacement,there were significant difference compared with the control group (P<0 05),NK cell activity was decreased significantly in patients with double valve replacement (P<0 05).On 8th days,T-lymphocyte subsets returned to the preoperative levels,NK cell activity didn′t recover in control group with double valve replacement(P<0 05).Conclusion It is suggested that nutrition support can improve the cellular immunity in patients of cardiopulmonary bypass and shorten the time of recovery.