早期肠内营养对老年食管贲门癌患者术后营养状况及免疫功能的影响

Effects of early enteral nutrition on nutrition status and immune function in elder patients underwent esophageal cardiac cancer surgery

目的探讨早期肠内营养(EN)对老年食管贲门癌患者术后营养状况、肠黏膜通透性及免疫功能的影响。方法行食管贲门癌手术患者96例分为两组,术后分别采用肠内营养(EN组,50例)和肠外营养(PN组,46例)。比较两组患者术后恢复情况,监测肝功能,检测外周血二胺氧化酶(DAO)活性、D-乳酸水平、血浆内毒素含量以及血液炎性细胞因子和免疫球蛋白含量等。结果与PN组比较,EN组患者术后排气排便时间早、并发症少、住院时间短、白蛋白水平高(P<0.05)。术后第7天,EN组DAO活性、D-乳酸水平和内毒素含量均低于PN组(P<0.05),而血浆IgA、IgG、IgM、CD4的水平均高于PN组(P<0.05),IL-2、IL-6和TNF-α均低于PN组(P<0.05)。结论早期EN可有效改善老年食管贲门癌患者术后营养状况,保护肠黏膜屏障,并能有效提高患者术后的免疫功能。

Objective To investigate the effects of early enteral nutrition（EN）on nutrition status,intestinal mucosal permeability and immune function in elder patients underwent esophageal cardiac cancer surgery.Methods Ninety-six elder patients underwent esophageal cardiac cancer surgery were treated with early EN（group EN,50cases）and with parenteral nutrition（group PN,46cases）.The postoperative recovery,liver function,activity of diamine oxidase（DAO）,plasma D-lactic acid and endotoxin,inflammatory cytokines and immune globulins before and after operation were detected and compared between two groups.Results Compared to group PN,the patients in group EN had earlier exhaust and defecation,less postoperative complications and hospital stay,and higher level of plasma albumine（P〈0.05）.The DAO activity and plasma levels of D-lactic acid and endotoxin on the 7th day were lower in group EN than those in group PN（P〈0.05）.Plasma levels of IgA,IgG,IgM and CD4 on the 7th day were higher,but those of IL-2,IL-6and TNF-αwere lower,in group EN than those in group PN（P〈0.05）.Conclusion Compared to PN,early EN is more effective in improving nutrition status and intestinal mucosal permeability,and elevating immune function in elder patients underwent esophageal cardiac cancer surgery.